Concurrent with the advances in medical science always come new dilemmas, debates
and obstacles that make living or dying more complicated rather than less.
Case in point is a recent news release from the The Association of American
Physicians and Surgeons (AAPS).
On June 19, a physician caught in the act of performing a sex-selection abortion was
arrested in a town near New Delhi and remanded into judicial custody for 14 days,
along with the woman's husband. They were charged with violating the Pre-Natal
Diagnostic Techniques and Medical Termination of Pregnancy Acts.
Prime Minister Manmohan Singh called sex-selection abortions a "national shame."
He called such abortions "inhuman, uncivilized and reprehensible" (LifeNews.com
Because of frequent female infanticide and selective abortion of girls, the birth
ratio was 927 girls born for every 1,000 boys in 2001, down from 962:1,000 in 1991.
The severe shortage of brides in the Haryana region has resulted in a black market
in women from other regions who are brought in and sold into marriage, according to
a Meri News report.
As many as 200 million girls may have been killed worldwide in this way, mostly in
Muslim and Asian countries. The rate is increasing because of ultrasound technology
that permits sex identification around 18 weeks.
Using data from the U.S. 2000 census, researchers have noticed a male sex bias in
U.S.-born children of Chinese, Korean, and Asian Indian parents. The effect of birth
order is striking. There is a normal sex ratio, 106 girls to 100 boys, for first
births. If the first birth is a son, the sex ratio of second children is also
normal. But if the first child is a girl, the second child tends to be a boy. And if
the first two are girls, the third is 50% more likely to be a boy.
Authors Douglas Almond and Lena Edlund conclude that sex-selection abortion was
being practiced in America as early as a decade ago.
According to a Zogby/USA today poll, 86% of Americans favor banning this practice,
which is seen by many as the ultimate form of sex discrimination. Every year that he
was in the U.S. Senate, Jesse Helms introduced a bill providing that "it shall be
illegal to perform an abortion for the sole purpose of sex selection" (Population
Research Institute Weekly Briefing 4/15/08).
On one hand The American College of Obstetrics and Gynecology (ACOG) states that
"helping patients to choose the sex of their offspring to avoid serious sex-linked
genetic disorders is considered ethical for doctors, but [on the other hand]
participating in sex selection for personal and family reasons, such as family
balancing, is not."
Since, however, it would be unethical to withhold medical information, such as the
sex of the fetus, from patients who request it, it "may be impossible to avoid
unwitting participation in sex selection."
ACOG reassures physicians that "they are not obligated to perform an abortion, or
other medical procedure, to select fetal sex" according to a Feb 1, 2007, news
The ACOG Committee on Ethics Opinon No. 360, February 2007, is silent on the issue
of whether physicians ought to refer patients to other providers who do not have
qualms of conscience about such abortions.
A controversial later opinion, No. 385, issued November 2007, entitled "The Limits
of Conscientious Refusal in Reproductive Medicine," states that "conscientious
refusals should be limited if they constitute an imposition of religious or moral
beliefs on patients, negatively affect a patient's health, are based on scientific
misinformation, or create or reinforce racial or socioeconomic inequalities."
Parenthetically, this opinion is being reconsidered because of concerns that
pro-life physicians could be decertified for "violation of ACOG rules and/or
ethics principles," say for failure to assure timely access to abortion or
emergency contraception (AM News 4/14/08).
Sex-selection abortion could create a major challenge for the hierarchy of ACOG
values and "core" elements of the practice of medicine. According to Committee
Opinion No. 385, these include patient autonomy; "maximum accommodation" to
"authentic claims" of conscience; sexual equality; and safe, timely, and
financially feasible access to abortion.
And soo it seems that with any medical or societal issue relating to abortion the
debate goes on and on and on.