Gil Siegal, a University of Virginia School of Law professor, medical doctor and native of Israel, has been appointed to chair the Israeli National Committee on Non-Medical Sex Selection. The committee, under the country's Ministry of Health, vets petitions from parents who wish to scientifically predetermine the sex of their child.
Although the practice of non-medically required sex-selection, which involves in vitro fertilization and checking a single cell for sex chromosomes, is largely prohibited in the nation, Israel does allow it under limited circumstances by a formal adjudication process. Of the approximately 300 couples who have received approval in the last 10 years of regulating the practice, most already had four or more children of the same sex and none of the other sex.
In addition to serving on other national health-related committees, Siegal is director of the Center for Health Law and Bioethics at Kiryat Ono College in Israel, senior researcher at the Gertner Institute for Health Policy and chief editor of The Journal of Health Law & Bioethics.
Siegal acknowledges that sex-selection raises complex moral and ethical concerns. He answered a number of the questions people typically have about the practice and discussed his new role.
Where does Israel fit with how other countries address sex selection?
Regulation of sex selection of embryos varies around the globe. Israel has pioneered a regulatory response, as opposed to a complete ban in the European Union, Australia or Canada, or a no-regulation, hands-off approach in the U.S.
What will your responsibilities be as chairman? Will you be reviewing and making decisions on applicants' requests directly?
I oversee the process that involves a deposition, psychological evaluation and a committee's vote. If parents are turned down, they have the right for appeal and to present to the committee. This is usually very hard emotionally.
Is it appropriate for human beings to influence a natural process such as sex assignment?
Well, medicine is about changing the course of nature in ways that seem as beneficial and as harmless as possible. In vitro fertilization changes the "natural" state of infertility to a happier fertile status. However, once you have the technology, spillage to non-medical areas such as non-medical sex selection happens, and a need for a decision on "to regulate or not" emerges.
What are the ethical and practical concerns?
Numerous concerns arise. Are we favoring one sex over the other? In the Middle East, where traditional cultures predominate, a strong preference for male is deeply rooted, hence a restrictive attitude seems right. Also, most women are healthy and can conceive naturally. This process exposes them to added risks and costs associated with IVF. In the same line, is the woman making a free choice or is she forced into it by others? Should we allow parents to dictate the sex of their offspring? Is it really part of human autonomy? Are we commodifying children? And more.
Should the government be involved in this process?
That is a tough one. We have strong reservations about governmental interference with our bodies, our life-decisions. However, as in most Western societies, health care in Israel is provided by the National Health System, and thus use of medical technology is regulated. The same happens elsewhere, such as in England, where the Humane Fertilization and Embryo Authority supervises the entire assisted reproduction field.
The preference among applicants has been to preselect for males. What are the reasons, and is sexism a valid criticism in these instances?
Preselecting for male is somewhat more prevalent in the petitions. It comes down to 35 percent female to 65 percent male on average. That is why regulation in Israel only allows it, if at all, after having several children from the opposite sex.
But I would point out that the practice of sex selection is very uncommon. From about 50,000 eligible families with four children of the same sex and none of the opposite, less than a hundred petition the committee annually. So overall, Israelis do not care about the sex of their children as much as expected.
What is the future of this practice, and where is it headed for countries that do not regulate it?
The future is not clear. After 10 years of regulating the practice, we do not see a huge increase in the demand, mostly because it is not as important, and because we have a restrictive policy. Again — most Western countries forbid it altogether, but we feel some room for individual circumstances should be allowed. However, in places without any regulation, parental desires and wants, coupled with better medical technology, does create a concern of a growing attempt for intervention. That is something worth much deliberation.
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