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Abstract

This study – the first to explore how infertility providers confront several critical dilemmas concerning sex selection of embryos for nonmedical, social reasons – highlights key challenges and questions. Clinicians struggle, for instance, with how to define “family balalancing”, when to offer it, and how to decide.

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References

Madan and

M. H.

Breuning , “Impact of Prenatal Technologies on the Sex Ratio in India: An Overview,” Genetics in Medicine 16, no. 6 (2014): 425-432; A. Sen, “Missing Women,” British Medical Journal 304, no. 6827 (1992): 587-588; The Geneva Centre for the Democratic Control of Armed Forces, “Women in an Insecure World. Violence against Women: Facts, Figures and Analysis,” available at <http://www.unicef.org/emerg/files/women_insecure_world.pdf> (last visited October 25, 2016).

Committee for Ethics, American Congress of Obstetricians and Gynecologists (ACOG), “ACOG Committee Opinion No. 360: Sex Selection,” Obstetrics & Gynecology 109, no. 2 (2007): 475-478.

Ethics Committee of the American Society for Reproductive Medicine (ASRM), “Preconception Gender Selection for Non-medical Reasons,” Fertility and Sterility 82, Supp. 1 (2004): S232-S235.

Ethics Committee of the American Society for Reproductive Medicine (ASRM), “Use of Reproductive Technology for Sex Selection for Nonmedical Reasons,” Fertility and Sterility, 103, no. 6 (2015): 1418-1422.

Id .

Id.;

Wilkinson

, “‘Designer Babies’, Instrumentalisation and the Child's Right to an Open Future,” in

Athanassoulis

, ed., Philosophical Reflections on Medical Ethics (New York: Pal-grave Macmillan, 2005): 44-69; V. Seavilleklein and S. Sherwin, “The Myth of the Gendered Chromosome: Sex Selection and the Social Interest,” Cambridge Quarterly of Healthcare Ethics 16, no. 1 (2007): 7-19; S. Puri and R. D. Nachtigall, “The Ethics of Sex Selection: A Comparison of the Attitudes and Experiences of Primary Care Physicians and Physician Providers of Clinical Sex Selection Services,” Fertility and Sterility 93, no. 7 (2010): 2107-2014; A. L. Kalfoglou, M. Kammersell, S. Philpott, and E. Dahl, “Ethical Arguments for and against Sperm Sorting for Non-Medical Sex Selection: A Review,” Reproductive Biomedicine Online 26, no. 3 (2013): 231-239.

Dahl ,

R. S.

Gupta ,

Beutel ,

Stoebel-Richter ,

Brosig , and

H. R.

Tinneberg et al., “Preconception Sex Selection Demand and Preferences in the United States,” Fertility and Sterility 85, no. 2 (2006): 468-473.

See Kalfoglou et al., supra note 6;

Savulescu and

Dahl , “Sex Selection and Preimplantation Diagnosis: A Response to the Ethics Committee of the American Society of Reproductive Medicine,” Human Reproduction 15, no. 9 (2000): 1879-1880; E. Dahl, “The 10 Most Common Objections to Sex Selection and Why They Are Far from Being Conclusive: A Western Perspective,” Reproductive Biomedicine Online 14, no. 1 (2007): 158-161; J. A. Robertson, “Preconception Gender Selection,” American Journal of Bioethics 1, no. 1 (2001): 2-9.

See Puri and Nachtigall, supra note 6.

10.

Collis

, “Preimplantation Genetic Diagnosis for Gender Selection in the USA,” Ethics, Bioscience and Life 4, no. 3 (2009): 16-22; N. Gleicher and D. H. Barad, “The Choice of Gender: Is Elective Gender Selection, Indeed, Sexist?” Human Reproduction 22, no. 11 (2007): 3038-3041.

11.

Kolker ,

B. M.

Burke , and

J. U.

Phillips , “Attitudes about Abortion of Women Who Undergo Prenatal Diagnosis,” Research in the Sociology of Health Care 9 (1991): 49-73.

12.

Newport

, “Americans Prefer Boys to Girls, Just as They Did in 1941,” Gallup, June 25, 2011, available at <http://www.gallup.com/poll/148187/americans-prefer-boys-girls-1941.aspx> (last visited October 25, 2016).

13.

Jain ,

S. A.

Missmer ,

R. S.

Gupta , and

M. D.

Hornstein , “Preimplantation Sex Selection Demand and Preferences in an Infertility Population,” Fertility and Sterility 83, no. 3 (2005): 649-658.

14.

S. A.

Missmer and

Jain , “Preimplantation Sex Selection Demand and Preferences among Infertility Patients in Midwestern United States,” Journal of Assisted Reproduction and Genetics, 24, no. 10 (2007): 451-457.

15.

M. G.

Katz ,

Fitzgerald ,

Bankier ,

Savulescu , and

D. S.

Crain , “Issues and Concerns of Couples Presenting for Preim-plantation Genetic Diagnosis (PGD),” Prenatal Diagnosis no. 22, no. 12 (2002): 1117-1122.

16.

See Missmer and Jain, supra note 13.

17.

R. R.

Sharp ,

M. L.

McGowan ,

J. A.

Verma ,

D. C.

Landy ,

McAdoo , and

S. A.

Carson et al., “Moral Attitudes and Beliefs among Couples Pursuing PGD for Sex Selection,” Reproductive Biomedicine Online, 21, no. 7 (2010): 838-847.

18.

See Sharp et al., supra note 15.

19.

See Collis, supra note 11.

20.

See Gleicher and Barad, supra note 11.

21.

Puri ,

Adams ,

Ivey , and

R. D.

Nachtigall , “‘There is Such a Thing as Too Many Daughters, but Not Too Many Sons’: A Qualitative Study of Son Preference and Fetal Sex Selection among Indian Immigrants in the United States,” Social Science & Medicine 72, no. 7 (2011): 1169-1176.

22.

Baruch ,

Kaufman , and

K. L.

Hudson , “Genetic Testing of Embryos: Practices and Perspectives of US in Vitro Fertilization Clinics,” Fertility and Sterility 89, no. 5 (2008): 1053-1058.

23.

Klitzman ,

Zolovska ,

Folberth ,

Chung ,

Sauer , and

Appelbaum , “Preimplantation Genetic Diagnosis on In Vitro Fertilization Clinic Websites: Presentations of Risks, Benefits and Other Information,” Fertility and Sterility 92, no. 4 (2009): 1276-1283.

24.

Klitzman ,

Chung ,

Marder ,

Shanmugham ,

L. J.

Chin , and

Stark et al., “Views of Internists Towards Uses of PGD,” Reproductive Biomedicine Online 26, no. 2 (2013): 142-147; R. Klitzman, K. J. Abbate, W. K. Chung, R. Ottman, C. S. Leu, P. S. Appelbaum, “Views of Preimplantation Genetic Diagnosis among Psychiatrists and Neurologists,” Journal of Reproductive Medicine 59, no. 7-8 (2014): 385-392.

25.

Ehrich ,

Williams ,

Farsides ,

Sandall , and

Scott , “Choosing Embryos: Ethical Complexity and Relational Autonomy in Staff accounts of PGD,” Sociology of Health & Illness 29, no. 7 (2007): 1091-1106.

26.

See Kalfoglou et al., supra note 6.

27.

See Puri and Nachtigall, supra note 6.

28.

See Ethics Committee of the ASRM, supra note 4

29.

Savulescu and Dahl, supra note 9; Dahl, supra note 9.

30.

Taylor-Phillips ,

Freeman ,

Geppert ,

Agbebiyi ,

O. A.

Uthman1 , and

Madan et al., “Accuracy of Non-invasive Prenatal Testing Using Cell-Free DNA for Detection of Down, Edwards and Patau Syndromes: A Systematic Review and Meta-analysis,” BMJ Open 6, no. e010002 (2016), available at <http://bmjopen.bmj.com/content/6/1/e010002.full> (last visited October 25, 2016).

31.

Klitzman

, “How Old Is Too Old? Challenges Faced by Clinicians Concerning Age Cutoffs for Patients Undergoing In Vitro Fertilization,” Fertility and Sterility 106, no. 18 (2016): 216-224.

32.

Guest ,

Bunce , and

Johnson , “How Many Interviews are Enough? An Experiment with Data Saturation and Variability,” Field Methods 18, no. 1 (2006): 59-82.

33.

Geertz

, Interpretation of Cultures: Selected Essays (New York: Basic Books, 1973).

34.

Strauss and

Corbin , Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory (Newbury Park, CA: SAGE Publications, 1990); see Collis, supra note 11; Gleicher and Barad, supra note 11.

35.

Klitzman ,

Thorne ,

Williamson ,

Chung , and

Marder , “Disclosures of Huntington Disease Risk within Families: Patterns of Decision-Making and Implications,” American Journal of Medical Genetics 143A, no. 16 (2007): 1835-1849; R. Klitzman, P. S. Appelbaum, A. Fyer, J. Martinez, B. Buquez, and J. Wynn et al., “Researchers' Views on Return of Incidental Genomic Research Results: Qualitative and Quantitative Findings,” Genetics in Medicine 15, no. 11 (2013): 888-895; R. Klitzman, “Institutional Review Board Community Members: Who Are They, What Do They Do, and Whom Do They Represent?” Academic Medicine 87, no. 7 (2012): 975-981; R. Klitzman and S. Daya, “Challenges and Changes in Spirituality among Doctors who Become Patients,” Social Science & Medicine 61, no. 11 (2005): 2396-2406; R. Klitzman, “How Good Does the Science Have to Be in Proposals Submitted to Institutional Review Boards? An Interview Study of Institutional Review Board Personnel,” Clinical Trials 10, no. 5 (2013): 761-766.

36.

Bodri

, “Risk and Complications Associated with Egg Donation,” in

M. V.

Sauer

, ed., Risk and Complications Associated with Egg Donation (London: Springer-Verlag London, 2013): 205-219.

37.

See Ehrich, supra note 33; Gleicher and Barad, supra note 11.

38.

Mackenzie and

Stoljar , “Introduction: Autonomy Reconfigured,” in

Mackenzie and

Stoljar , eds., Relational Anatomy: Feminist Perspectives on Autonomy, Agency and the Social Self (New York: Oxford University Press, 2000): 514-533.

39.

See Ehrich, supra note 23;

J. L.

Scully ,

Shakespeare , and

Banks , “Gift Not Commodity? Lay People Deliberating Social Sex Selection,” Sociology of Health & Illness, 28, no. 6 (2006): 749-767.

40.

T. L.

Beauchamp and

J. F.

Childress , Principles of Biomedical Ethics (Oxford/New York: Oxford University Press, 2008).

41.

See Puri and Nachtigall, supra note 6.

42.

See Taylor-Phillips et al., supra note 28.

Struggles in Defining and Addressing Requests for “Family Balancing”: Ethical Issues Faced by Providers and Patients

Abstract

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References