Monica Doumit: New ethics guidelines for IVF suggest it’s bad luck for girls

Trying to justify the unjustifiable: ethics body considers sex-selection, which usually happens at the expense of girls.

The national Health and Medical Research Council (NHMRC), the body charged with setting ethical standards for medical practice, has spent the last four years reviewing its guidelines on the use of assisted reproductive technologies.

The guidelines were released last week and the results – I must say – were underwhelming.

When it comes to the use of assisted reproductive services in Australia, an IVF clinic needs to comply with the NHMRC guidelines in order to obtain a license to offer assisted reproduction.

One of the mooted revisions to the guidelines related to whether IVF could be used to select the sex of a child.

Under current rules, IVF may only be used for sex selection where there is a medical reason to do so.

But there was a suggestion that the new guidelines might permit sex selection for non-medical reasons. It was this potential revision which was most anticipated.

In order to determine whether to change this rule, the NHMRC, via the Australian Health Ethics Committee (AHEC), sought public opinion on sex selection by posing a number of scenarios in which a hypothetical couple might seek to use sex-selective IVF: they want two children of the same gender; they only want two children, and want them of different genders; they already have two children of the same gender, and want a third of a different gender; or for cultural reasons, they have a preference for a particular gender.

When reading the scenarios posed by the NHMRC, I couldn’t help but be troubled by the underlying premise which suggested that the ethics of an action depended on the motive behind it.

What was being assessed by the NHMRC was not the ethics of using IVF for sex selection, but the reasons for doing so. Ethics 101 teaches us that the ethics of an act does not depend on the surrounding circumstances; if an act is wrong, then it is wrong – end of story.

But alarmingly, Australia’s peak medical body based a critical public consultation on the suggestion that it could. And even more alarmingly, it based its conclusions on the same. It boggles the mind!

The final revised guidelines, released last week, stated that the majority view of the AHEC was that there was an ethical difference between a couple using sex selection to give birth to children of both genders and a couple using sex selection to give birth to a child of a certain sex based on personal or cultural bias.

I’m not sure there is.

To be honest, I think that the reasons for wanting a ‘balanced’ family which includes children of both genders could be just as much based on “personal or cultural bias” as were the reasons for preferring a child of a particular gender.

And if we are being honest, the use of IVF for “medical” reasons – to avoid having a child with a particular genetic condition – can also be a matter of “personal or cultural bias.”

Overwhelmingly, the public opposes gender selection for cultural reasons because it treats one gender – usually females – as second-class citizens.

But doesn’t eliminating a child on the basis of a genetic condition equally treat a group of people as second-class citizens as well?

Of course it does; but when Australia’s peak ethical body abandons basic ethical principles, we end up with stupid results!

Not only did the AHEC and the NHMRC abandon ethical principles in coming to this decision, they seem also to have ignored their role in the first place.

In continuing the prohibition on the use of sex selective IVF, the AHEC said that there was “limited research into the question of whether Australians support the use of sex selection for non-medical purposes” and so the ban would remain “until such time that wider public debate occurs and/or state and territory legislation addresses the practice.” Surely the role of the AHEC and the NHMRC is to inform the public and guide the legislature, rather than be led by it.

After all, the AHEC and the NHMRC were not established to gauge public opinion. They are not polling companies, but specialised ethical bodies established by federal law to ensure our practices are proper.

But when institutions established for the purpose of setting benchmarks for ethical practice abandon the notion that the ethics of an action are unchanged by surrounding circumstances, and instead propose that they can differ based on the intentions of those undertaking the action or the opinions of the public, then we end up with the confusing and ultimately useless guidelines released by the NHMRC last week.