When Not to Choose: A Case Study Betty B. Hoskins, Ph.D.* Helen Bequaert Holmes, Ph.D.
ABSTRACT: Life situations often seem to require duaJistic, efther or Uec;s~on making, but this common method does not always c/arif~ moral decisions. To show this, standard, arguments on why to choose or not to choose the ~ex oT o,~.e ,. child are #resented. Then, our feminist thinking, which regards clusters of vaJues, and which re#ames questions, rather than choosing between desirable afternati~ es, - ~s.uggestsanothe~'.possibiiity~ i~a gynand~ous w.or!d vision.
INTRODUCTION
Much o f our decision making, is presented as requiring the making of choices. Some of these:choices seem innate, or biological; we shall have a boy or a girl child (in the "normal" range of events). Some choices seem either, natural, Or..imposed by ou[ brain structure on the natural; most .bioiogjca~-keys.,are dichotomous., and the mos~effective keys are thought to present :only:two cboi.ces at. a tirade. ")knd we are assured that not to chOoSe is;i6.and~of, itself a: choice;. There: seem; howe!ver., to be cases in whichchanging the question represents a moreuseful form of reasoning. *These ideas on-dualism and feminist values develop within community. The biological and ethical considerations that provided the impetus for this article were developed for a National Women's Studies Association panel organized by Helen Bequaert Holmes for l une 1983; they appear in the anthology Test-Tube W o m e n - W h a t F u t u r e for M o t h e r h o o d ~ (Hoskins and Holmes, 1984). The ethical implications of feminism for dualistic thinking were presented by Betty B. Hoskins at Collegium, an Association of Liberal Religious Scholars, in October 1983. Dr. Hosk-ins is an independent scholar and Senior Technical Editor, to whom reprint requests can be addressed at 5 Paradox Drive, Worcester Massachusetts 01602. Dr. Holmes is the~1984-85 guest worker at the Science and Society Program, University of Groningen, The Netherlands. 28
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Betty B. Hoskins and Helen Bequaert Holmes
Either/or decision making is e m b e d d e d in Western thought. I t leads inevitably to rank-ordering and to j u d g m e n t o~ bet: ter/worse than. It, fits into a world view built up upon authority, rights, autonomy; abstract reasoning is valued highly. M y Encyclopedia Britannica (M.Ee., 1971) (which I shall use as a concise example) tells rne that': Generally speaking, the words (dualism and dualistic) refer to any system which in the interpretation of the universe as a whole or of some particular aspect of reality postulates the existence of two heterogenous and irreducible principles; for example, God and the world, matter and spirit, being and thought, or good and evil. In asserting that certain opposed terms are dualistic, the intention is not simply to acknowledge their dissimilarity, but primarily to insist on the irreducibility of their difference. In Comparative Religion--A certain kind of dualism is implied in every religion by the simple fact that the sacred is considered to be radically different from and opposed to the profane. Moreover, all polytheistic religions recognize a class of supernatural beings (such as demons, Titans, monsters) which are different from and antagonistic to the gods. Even within a singte pantheon of divinities, there may be noted a tension and a conflict between the celestial and the terrestrial or chthonian gods . In Philosophy--For Plato, the intelligible world is separated from and opposed to the sensible world; the pre-existent soul is forcibly united with the bod% The ideal world, though transcendent, is not hostile ~to the material one; there is a duality rather than a dualism. Neoplatonism, however, accentuated the opposition between spirit and.matter, soul and body, reason and the senses. [The dualisms of Descartes, Leibniz, and Kant are then considered.] Although this is a predominant way of reasoning, we find vestiges, glimmers, of other possibilities. We do not customarily try to choose between the good, the true, and the beautiful, for example. And the insistence within America rt tradition upon pluralism suggests the c o m p l e x i t y of real life. ' ~heQuestian
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It is now possible to attempt to choose the sex of one's child. There are, in this country; at least seven clinics that offer services for " m a l e infertility and male sex preselectionT' In reviewing the embryological and medical literature on the d e v e l o p m e n t of such techniques, we f o u n d research toward this goal, all over the world. There are Indonesians working in Belgium, Israelis working in France, researchers in Sweden, India, and the U.S.A. Most of the research aims t o w a r d the choosing of male children.
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' What we shall" do-in this paper is look at the arguments for and again.st.sex preselection, in our present value system, which can be defined as predominantly patriarchal. The analysis will be within a feminist cluster of values. Finally, we shall question whether We would choose, were our world structure different.
THE T E C H N O L O G Y FOR SEX PRESELECTION
Some techniques select sex before conception; others detect the sex of a developing embryo, for possible elimination• Although at present few of these techniques have been fully investigated, sex preselection or detection might become possible at any of the stages before birth• These stages, all of which are available to manipulation, are: the sperm or egg; fertilization (whether by intercourse, artificial insemination, or in vitro procedures); early embryo (when cells divide to form an inner cell mass and a pre-placenta); late embryo (when organ rudiments or organs are present];" and fetus (after two. months in uterus). Potentially, parthenogenesis and egg fusion could also be sex-choice technologies. All such techniques require medical intervention and treatment, as well as the involvement of a team of biologists, health care providers, biomedical instrumentation personnel, etc. Sperm separation is the technique that has received the most attention. Sperm contain, among 22 chromosomes, one X or one Y chromosome, which will determine at fertilization the sex of the offspring. Swimming a sample in a layered density gradient of protein solution can concentrate Y-bearing sperm up to 70 percent purity. This technique has been widely publicized by Ronald Ericsson (1983), and is used in. the U.S, laboratories offering selection toward male children. oA n o t h ~ technique.separates sperm by: pouring a. sample through an .ionized c0iumn of 'tesins. ii~this ~ase] X:sperm can be isolated a fraction Ul.~.to~90:percent"iSur.e(' (Steeno etaJ, 1975,. Adimoelja et al, 1977). BUt we have found ohiO; one.clihical:report.'[Caisone:t al, 1983) of the use o f this techni.o,ue to select for.female offspring! Other suggestions for enhancing the possibility of fertilization w i t h a n X- or Y-bearing sperm abound: timing: of intercourse, diet, position have all received repeated public and medical attention. The success rate of prediction is just about the same as chance. Still, articles continue to appear. The other sort of technique checks the sex of an embryo or fetus after ~oncep.tion, Recently, several new techn[ques have been
Betty B. Hoskins and Helen Bequaert Holmes
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described:~ detecting Y-specific DNA in chodonic placental tissue removed~ via the cervix (Gosden et al, 1982); measuring the level of testosterone (a hormone produced more in male than in female fetuses-) in maternal blood or saliva (Glass and Klein, 1981; Held et al, 1981); detecting fetal hormone levels in amniotic fluid (Mean et al, 1981); searching for fetal blood cells in maternal blood (Herzenberg et al, 1979); culturing amniotic cells for chromosome analysis; visualizing genitalia with ultrasound (deCrespigny & Robinson, 1981; Weldner, 1981). The last four techniques must be performed at the time the embryo has become a fetus, necessitating a second-trimester ab6rtion, should that be chosen.
W H Y PRESELECT?
Focussing medical research upon prese.lection rather than detection, seems preferable, if, that is, there is any reason to develop such techniques at all. What are such reasons? The predominant one may be the avoidance of sex-linked genetic diseases, which are carried on the Xchromosome and are most often expressed in the male child, who has an X-chromosome and a Y chromosome. The female child, with two Xchromosomes~ is simply the carrier of the unfortunate gene. For example, here isa published rationale:(USA) There are definite medical reasons for ensuring that a newborn infant is of a particular sex. Some 200 sexlinked genetic diseases have been described• These inc[ude Cooley's anemia, hemophitia . several types of muscular dystrophy... (which) could be prevented if the child were of the unaffected sex. (Quinlivan et al, 1982, p. 104) There are other reasons Stated in the medical literature for pursuing sex preselection, Some o f these are: - . (t-ndoni~sia, Belgium~" Esl~cial.l'y during th~ second half'of, this century, -'- sin'ce' the~whole, world "sl~ows an ."imminent. population expl0sion,, ex~ periments to predetermine the sex of a child become more active ... • (There) is.no doubt that the determination or method to have a child with the predetermined desired sex witl support family planning and life welfare. (Adimoelja et al, 1977, p. 289) (France) Man has always wanted to select his children's s e x . . . (Stolkowski & Choukroun, 1981, pp. 1061-1067)
(Sweden) [The] main use [of fetal sex determination by ultrasound] has been to satisfy the curiosity of parents. (Weldner, 1981, p. 333) -.
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Are there reasons why feminists might encourage the availability of such techniques? A reasonable response might be: This may be regarded as another dimension of the pro-choice position, that a woman has a legal right and moral responsibility to exercise reproductive freedom. No.legal restriction on family planning practices should be supported. Also, if sex preselection is an aspect of'family planning, some women may find themselves preferring to raise only girls, or only . boys, or some of each, in some desired order. Is there any reason to deny their choice? And.what of the family that simply does not wish to raise a girl or a boy? Should not every effort be made to spare a child that degree of unwantedness? Indeed, on most days I would argue that those who do not want to raise girls (more often the case than for boys) should receive every encouragement~to avoid that circumstance• Or imagine another woman who can stay well married only if she produces a son. To survive economically, she may wish to stay married; socially she may need the status provided by the birth of a son We may prefer a world in which sons are not means to an end; but we do not all live in that world. There may be advantages for a child who knows she was chosen. Today., man~ women are affected by knowledg~ that one or both parents would have preferred her as a boy. (Presumably~this may be true for some men also.) And, there may be arguments for structuring a society with a tilted sex ratio. Sally Miller Gearhart, for example, hag envisioned a population that is 90 percent female, in The Future-- if There Is One-- Is Female. Looking at our present aggressive society, she asserts that malebonding and male-ordered structures are clearly not viable, and proposes that egg fusion Could be used,i without any male killing; to try another -system. , ~ . ~: ' .... • ,-• "2
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Were sex preselection techniques widely in use in-our society, it is likely that male children would predominate. There is considerable evidence for that. Worldwide, interviewees say they want "balanced" families, equal numbers of boys and girls (Williamson, 1978; Steinbacher, 1983', Chico, 1983). But, when unequal numbers are desired, more boys are wanted. Several sociologists have predicted the effects of a malepredominant world (Etzioni 1968). Among the outcomes for
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example, they expected the rise of criminality, male homosexuality, and a black market in women, along with the decreasing support that women provide to the Republican Party- and the churches. (it is not clear if authors rate al| these as unfortunate outcomes.) Guttentag and Secord's recent careful book Too Many Women?. The Sex Ratio Question studied the effects of sex ratios in many historical situations on several continents (1983). In societies with a preponderance of males, they found more male commitment to wives and children. Typically, strong constraints on female behavior are present, such as dire penalties for non-virginity before marriage, and tight control over daughters and' wives. Female infanticide and neglect often occur• In India, with 96 women to every 100 men, girl babies have been and still are unwanted. Currently the technology of amniocentesis followed by selective abortion, although discouraged by the government, is. advertized and practiced (Chacko, 1982). Some writers advocate male sex preselection as a means to control the population. Clare Booth Luce, in one of her more striking feature articles, argued (1978) that the invention of a pill to "make most babies male" would reduce the number of wombs and solve overpopulation, especially in the Third World• Here, a striking blend of sexism, racism, and classism obscure the problems of economic maldistribution and social justice. ........ Also, desire for a boy or a g i r l c o n t a i n s Within i t p r e c o n ceptions on sex roles. Powledge, therefore, called sex preselection "the original sexist sin" (1981). Markle (1981 on the PBS show "Hard Choices") called it "the ultimate.form of sex discrimination" and further argued that peoples" reasons for wanting firstborn sons reflect machismo values and sexual prejudice such as carrying on a family name. Were sex chosen, girls would more often be second, or subsequent; siblings'. This. would reinforce~the birth order effects, in• which " fi-rstoborns ~en~ ~t o be mc~re assertive anot arab itious,~second born s to" b e more, accommodating and passive: We could. predict fewer women in •
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And, what about the "mistakes".7 Suppose a daughter is born as the '"fai[ure"--a word used in the medical l i t e r a t u r e - - o f a technique~ If someone went • to expense-and trouble to secure a son, would not the daughter suffer psychological, and perhaps physical, consequences? (The same would be true for a son born when a daughter was planned.) It is also clear, from life experience, that sons, even chosen sons, can be abused by the patriarchy. They may be driven, :by others'
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ambitions, by the messages of~our culture, to succeed or to die. The hierarchical,, c o m p e t i t i v e actions of daily society can damage selfesteem and stifle creativity. Even more, sons who try to escape patriarchal behaviors may find little place in the general or the feminist society. • A n d , sex preselection leading to a preponderance of w o m e n is not projected to produce a much better world, were the present predominant values to continue. Guttentag and Secord observed such c o m m u n i t i e s and reported: •[Men] can negotiate exchanges that are most favorable to them. Men are more reluctant to make a commitment to any one woman, and if they make it, it is a weaker one, and is more apt to be broken .. Women are more apt to feel exploited, because even when they meet a male partner's demands, he may break off the relationship . . This feeling of being exploited generates attempts by women to redefine male and female roles in a relationship, to reiect a male partner, and/or to reduce their dependency by becoming more independeht. Again, it is not clear that totally positive or totally negative outcomes are being predicted•
WHY, THEN, CHOOSE? We w o u l d hope that as the-result of a rational choice, with all factors weighed, a clear decision w o u l d result. In the case of sex preselection, this does not seem possible. However, we can argue within a different value base. a cluster o f feminist v a l u e s ; t h e n the. question of sex preselection simply n e e d not arise= A gynandrous-world m i g h t require few of the preceding considerat!on~. (Gynandrous means that we prefer to stress the w o m a n asso~:iated-trait~.. Jn-otir.linear language;.we immediately, express, choice by putting~the male andros or female.gynosfirst. The more c o m m o n w o r d
.'=androgyny,;' ca~ ~,iml~t~..that, w~e~are; favoring the: aggressive, naturedominating, world-conquering traits so prevalent in our world.) In.the summative essay of our previous study (Holmes,
Hoskins-'& Cross, 1980), we suggestecl that women's ethical perspectives attempt to maximize clusters of values, rather than trying to choose which one is of most importance. Thus women sense a connection to family, friends, neighbors {near and far), living creatures, the Earth . . . and frequently take all into consideration when deciding. (Editors have told us we idealize, we prescribe too hard a task; but we be.lieve we observe this, and that: anintellectually rigorous f o r m u l a t i o n of this ap-
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Betty B. Hoskins and Helen Bequaert Holmes
proach has not.been w o r k e d t h r o u g h c o m p l e t e l y yet. See also Elizabeth Dodson Cray's persuasive arguments in 1981 and 1982.) C i l l i g a n , in helr In a Different Voice (1982) h.as presented e m p i r i c a l e v i d e n c e that w o m e n reason w i t h i n an ethic of care. This ethic, which reflects a cumulativeknowledge of human relationships, evolves around a.central insight, that self and other are interdependent, (page 74). She shows that w o m e n ' s experiences i l l u m i n a t e a reality common to both of the sexes: the fact that in life you never see it all, that things unseen undergo changethough time, that there is more than one path to gratification, and that the boundaries between self and other are less clear than they sometimes seem. Thus women not only reach mid-life with a psychological history different frorn men's and face at that time a different social reality having different possibilities for love and for work, but they also make a different sense of experience, based on their knowledge of human relationships. Since the reality of connection is experienced by women as given rather than as freely contracted, they arrive at an understanding of life that reflects the limits of autonomy and control. As a result, women's development delineates the path not only to a less violent life but also to a maturity reialized through interdependence and taking care.
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C i l l i g a n ' firids-'the difigin~s of-aggressi6n i n . t h e f a i l u r e of conneCtibh. arid c o n c l u d e s her boolk In a Different Voice w i t h To understand how the tension between responsibilities and rights sustains the diallectic of, human experience ts to see the integrity of two disparate modes of experience that are in the end connected While an ethic o~ justice proceeds from the premise o6 equality--that everyone should be treated the same--an ethic of care. rests on the premise of non• vio!en(:e--tha~ no'one should be hurt. In.the representation, of maturity., b'oth ~perspectives-cbnverge in, t h e realization that just as inequality ad• versel~/.affectsboth-.part~es'in an unequal.relationship, so too violence is " .."destructive,foe, e~.~er$'one:~nVotVed, Th'is:dialogue.between fairness and c a r e . not only provides a better understanding of relations between the sexes but also gives rise to a more comprehensive portrayal of adult work and family relationships. .
W e have quoted extensively to give the flavor of Cilligan's t h o u g h t ; c l e a r l y C i l l i g a n , too, does not escape the d i c h o t o m i e s and tensions of o u r language. But there is here a rejoining of h u m a n experiences, a refusal to v a l u e one or d e v a l u e another, a reach t o w a r d i n c l u s i v i t y . So; w e believe that,, when facing a moral d.iien~ma, many
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women reason in this way: If a:problem seems solvable only by ranking values hierarchically and regarding some as less important, then refuse to choose. Instead, continue to reframe the problem until a question can be asked whose answer will incorporate all of the pertinent values. Colloquially, if asked which slice of pie you want, it is often sensible to ask to see the other pies. Applying this feminist perspective to sex preselection, what, in a gynandrous world? In such a world, we envision, each child would be planned--as a child--and welcomed at birth as herself or himself Roles would not be expected or applied. Technologywodld be appropriate, using as little energy and machinery as suitable, maintaining the dignity of persons and the earth. High technology would be reserved for crucial inLerventions, and the participation of those affected would be sought and fully used in the decision process. In a profound sense, fewer choices would be made. Many of our present troubles result from needless dualisms, such as whether the mind is "better than" the body, whether professlonals are more valuable than hand laborers, whether "man must rule over the earth," whether the male power-concept is preferable to the female empowerment ~deals. We conclude that we should acz in ways that avoid unnecessary choices, and that. in the case of sex preselection, a reasonable stance would be not to choose a girl or boy, but to welcome each child. . . . . . . . . . . . . . . . .
REFERENCES Adimoelia. A_'Hariadi, R~. Amitaba, I G.B., Adisetva. P.. & Soeharna. The separation of X.and, Y-spermatozoa with regard to the oossible clinical application by means of artificial i~nseminlation, andrologia, 9:3, 1977. pp. 289-292. Chack0, A. Too,many daughters? India's.~Jrastic cure. World Paper, November 1982. Chlc~ N~ Persowal~Communlcat~on. dat~ fc~ Ph, D. dtssertatlor~, 1983. .Carson, S., L.. Batzer. F. R.= & Schlaff, S. Preconception female gende r selection• Fertility and -., :; Steril.it¥, 40:3;.I .~3~ PI~. 384-3155. de~Zfisplgn%.L..C:-~ ~obins0n.~H.P. Di~terminatibn,of"fetal°se~cwith ultrasound. Medical Jour- " " nal of Australia, 2. lulv 25. 1981 I~I~.98-I00 Dodson Gray, E: Green Paradise Revisltecl. Wellesley ,Mass.. Roundtable Press, 1981 Dodson Gray, E. Patriarchy as a ConcelJtual Tral~. Wellesle~ Mass.: Roundtable Press, 1982. E'e., M. Dualism. Encyclopedia Britannica. Volume 7, Chicago: William Benton, 1971. pp. 717-718.
Etizioni, A. Sex control, science, and society. Science 161: 1968, pp. 1107-1112. Gearhart, S.M. The Fuiure--lf There is One--is Female. In McAllister, P (Ed,) Reweaving the Web of Life: Feminism and Nonviolence. Philadelphia: New Society Publishers, 1982. pp. 266-284. Gilligan, C. In a Different Voice: Psychological Theory and Women's Development. Cam, -.. bridge.Mass:Harvard Uniy. press,1982:
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Glass,.A.R. & Klein, T. Changes in maternal serum total and free androgen levels in early pregnancy" Lack of.correlati0n with fetal sex. American Journal of Obstetrics and Gynecology 140:1981, pp. 656-660. Gosden, J.R., Mitchell, A.R., Gosden, C,M.. Rodeck, C.H. & Morsman, J.M. Direct vision chorion biopsy and chromosome-specific DNA probes for determination of fetal sex.in first-trimester prenatal diagnosis. The Lancet, 2 December 25, 1982, pp. 141 6.1419 Guttentag, M. &" Secord, P.F. Too Many Women? The Sex Ratio Question. Beverly Hills, Sage Publications, 1983. Held, K.R., Burck, U. & Koske-Westphal, Th. Pranatale Geschlechtsbestimmung dutch den GBN-Speicheltest. Ein Vergleich mit den Ergebnissen der pranatalen Chromosomendiagnostik. Geburtshilfe und Frauenheilkunde 41, pp. 619-621 Herzenberg, LA., Bianchi, D.W.. Schroder, J., Conn, H.M. & lverson, G M . Fetal cells in the blood of pregnant women: Detection and enrichment by fluorescence-activated cetl sorting. Proceedings of the National Academy of Science, USA 76. 1979, pp 1453-1455. Holmes, H.B., Hoskins, B.B. & Gross, M (Eds.) The Custom-Made Child? VVomen-centered Perspectives. Clifton N J: Humana Press, 1981 Hoskins. B.B. & Holmes, HB. Technology and Prenatal Femicide In Arditti, R, Klein, R.D and Minden, S. Test-tube Women-- What Future for Motherhood? Boston: Routledge & Kegan Paul. 1984, p p 237-255. Luce, C.B. Next: Pills to make most babies male. Washington Star July 9, 1978, C-1, C-4. Markle, Boy or Girl? Should the choice be ours? First Broadcast January 2 1981. in Public Broadcasting Series Hard Choices. Transcripts available from PTV Publications. P O Box 701. Kent OH 44240 Mean, M., Pescia, G., Vajda, D., Pelber, J.B., & Magrini, G. Amniotic fluid testosterone m .. 4. 1981, pp 441-447 prenatal sex determination. Journal de Cenetique humaine .~c~. Powledge, 1" Unnatural Selection: On Choosing Children's Sex In HoJmes Hoskms. and Gross, op. cit.; 1981, pp. 193-199 Quinlivan, W.L., Preciado, K., Long, T.L. & Sullivan, H. Separation of human X and'Y spermatozoa by albumin gradients and Sephadex chromatography Fertility and Sterilff.v. 3Z.-1,198-2: pp;-104~:107-. • . . . . . . . . . . . . Raymond, J. (Ed.) Sex Preselection. In Holmes. Hoskins, and Cross, op. cit., p p 177-224. Steinbacher, R. Sex Preselection: From Here to Fraternity. In Gould, Carol, editor Beyond Domination: New Perspectives on Women and Philosophy. Totawa N I: Littlefield, Adams, 1983 Steeno, O , Adimoelia. A. & Steeno. J. Separation of X- and Y-bearing human spermatozoa with the Sephadex gel-filtration method. Andrologia 7:1975, pp, 95-97. Stolkowski, J. & Choukron, J. Preconception selection of sex in man. Israel Journal of , Medical Sciences 17: 1981, pp+ 1061-t067. •, Weldner, E-M. Accuracy of fetal sex 'determination by ultrasound. Acta Obstetrica et Gynecologica Scandinavia, 60: t981, pp. 333-334. ' . WIIliamson, N-.E.. BO¥,sor Gir.la? Patents? Preferences. and Sex, Control. Population Bulletin. Washington DC: Population Reference Bu~:eau,=1978~