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But while the technique is ideal for weeding out this and other X-linked disorders, including hemophilia, Duchenne muscular dystrophy and Fragile X syndrome, most patients treated at Genetics & IVF want to even out their families--a life-style rather than a medical decision. The Fairfax clinic has been willing to help, but such a trend doesn't sit well with some other practitioners. "Our view at the moment," says Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility at Cornell Medical Center in New York City, "is that these techniques should be used for medical indications, not family balancing."
But now that parents know that the technology is available, and that at least some clinics will let them choose a child's gender for nonmedical reasons, it may be too late to go back. In a relatively short time, suggests Princeton University biologist Lee Silver, whose book Remaking Eden addresses precisely these sorts of issues, sex selection may cease to be much of an issue. His model is in vitro fertilization, the technique used to make "test-tube" babies. "When the world first learned about IVF two decades ago," he says, "it was horrifying to most people, and most said that they wouldn't use it even if they were infertile. But growing demand makes it socially acceptable, and now anybody who's infertile demands IVF."
That's not to say in vitro fertilization hasn't created its own set of ethical problems, including custody battles over fertilized embryos that were frozen but never used, questions about what to do with the embryos left over after a successful pregnancy, and the increased health risks posed by multiple births. Yet no one is suggesting the practice be stopped. Infertile couples would never stand for it.
Sex selection will undoubtedly raise knotty issues as well. Societies that value boys more highly than girls, including China and India, are already out of balance; this could tip the scales even further. Such an outcome is unlikely in the U.S., where surveys show that equal numbers of parents want girls as boys. But the same polls report that Americans believe an ideal family has a boy as the oldest child. Boys often end up being more assertive and more dominant than girls, as do firstborn children; skewing the population toward doubly dominant firstborns could make it even harder to rid society of gender-role stereotypes.
The ethical issues raised by techniques emerging from the genetics labs are likely to be even more complex. What if parents can use preimplantation genetic diagnosis to avoid having kids with attention-deficit disorder, say, or those predestined to be short or dullwitted or predisposed to homosexuality? Will they feel pressure from friends and relations to do so? And will kids who are allowed to be born with these characteristics be made to feel even more like second-class citizens than they do now?