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SCMP Reporter

THE issue of sex selection is a broad one and involves moral, ethical, religious, humanistic and social issues, all of which are contentious. This is why there is such wide discussion around the world.

  The issue has arrived on our doorstep, now that the doctors in London who pioneered this technique are applying to open a clinic in Hongkong.

  Because the Hongkong Medical Council does not have an ethics committee, my views are personal. I think in a year or two we will have an ethics committee and a more authoritative opinion can be given.

  First, the sex selection clinic should only be run under stringent medical conditions.

  Secondly, and more importantly, I believe that in Hongkong the justification for using such a service has to be medical.

  If there is no predisposing condition, from a medical point of view, the sex selection technique should not be accessible.

   It should be conducted under strict medical supervision.

   There is concern this facility could be abused and legally it would be difficult to prosecute unless there was legislation.

   While the Medical Council has no ethics committee, we should be much more careful in looking at these new ethical issues.

   From the medical point of view, the only possible use of the sex selection technique is to offer an alternative to the pre-natal diagnosis of certain X-linked inherited disorders.

   These conditions affect males much more than females. These are so-called sex-linked hereditary conditions.

   Abnormal genes are located on the X chromosomes and this affects males more than females. Each female has two X chromosomes, while each male has XY.

  One X chromosome is contributed by the oocyte of the mother, while the sperm of the father contributes either an X or a Y.

  A female who carries an abnormal gene on one X chromosome and a normal gene on the other will not develop the inherited disease after birth, although she may be a carrier.

  But if the male, who has one X chromosome, has an abnormal gene he is likely to develop the disease.

  These are conditions people can generally relate to - haemophilia, Duchenne muscular dystrophy and Fragile X syndrome, which gives rise to mental retardation.

  These conditions can be picked up by pre-natal diagnosis, carried out in early pregnancy or the first trimester. Using modern molecular biological techniques, the affected embryo can be aborted if the parents choose.

  THE only advantage of sex selection in this case is to screen out the Y carrying sperms so all the fertilised ova will result in baby girls.

  The parents will know that if they have a girl, she is 100 per cent safe. If it is a boy, the chances are 50-50.

  This sex selection technique may therefore help the parents avoid the difficult decision of choosing to abort an affected embryo and to undergo the abortion.

  In this respect, it may be less objectionable to the pro-life or religious bodies because of the argument that abortion means taking away a life.

  Having said that there are reservations even on medical grounds.

  Firstly, the success rate of the sex selection technique is not 100 per cent. It is claimed to be only 80 per cent, against a natural selection of 50-50.

  Secondly, there is no guarantee the sperms do not suffer any damage during the selection process.

  Lastly, hereditary conditions which are incurable today may not be so tomorrow. With progress in medicine and science, and the development of gene therapy, neither pre-natal diagnosis nor sex selection may be required in due course.

  If sex selection clinics were freely available and the parents chose to have boys, what would the world be like in 15 years? This will bring in moral, ethical, humanistic, social and economic issues.

   Most people in Hongkong are educated and do not care whether they have boys or girls. But in China they still do.

  Apart from the wider moral and ethical issues, the sex selection technique may only be applicable to cases with a strong family history of serious X-linked inherited disorders as an alternative to pre-natal diagnosis. It will select out the boys who may be affected.

   Parents who want to do this should go first for genetic counselling. There are well-established Government clinics and we have a good genetic counselling unit at the University of Hongkong, which is open to the public.

  Parents can be informed of the mode of the inheritance of the disease, whether it is X-linked, how strong the inheritance is, whether it is serious and what risks are involved.

  If the sex selection clinic came to Hongkong, it would have to be registered with the Department of Health, but it would be difficult for them to lay down any guidelines.

  In the United Kingdom also, there is no firm procedure to deal with it. I think it will be a matter of public opinion.

  People argue we interfere with nature every day by taking contraception.

  But at least with contraception, people know what is involved and contraception is not abused. This process can be abused.

 Professor Rosie Young is chairwoman of the Hongkong Medical Council.



Why we should remain wary of sex selection