Sebahat ATAR, Serap ŞAHİNOĞLU

306314

Tıbbi Olmayan Cinsiyet Seçimi: Yeni Teknolojiler – Teknolojik Gelişmeler ve Etik Tartışmalar

İstenilen cinsiyette bir bebeğe sahip olabilmek için gebelik öncesinden itibaren gebelik, doğum ve doğum sonrasını kapsayan süreç içinde yapılan, tıbbi veya tıp dışı her türlü eylem cinsiyet seçimi olarak tanımlanabilir. Cinsiyet seçimi, tıbbi veya tıbbi olmayan nedenler ile yapılabilir. Tıbbi nedenlerle yapılan cinsiyet seçimi etik açıdan uygun görülürken tıbbi ve sosyal açıdan yol açtığı istenmeyen sonuçlar nedeniyle tıbbi olmayan nedenler ile yapılan cinsiyet seçimi etik açıdan genellikle onaylanmaz. Cinsiyet seçimi sıklıkla erkek lehine yapılmakta, dolayısı ile kadının toplumsal değerini azaltırken cinsiyet ayrımcılığını arttırmaktadır. Tıbbi olmayan nedenlerle yapılan cinsiyet seçimi tıbbi, etik ve sosyal açıdan pek çok olumsuz sonuçlara yol açmaktadır. Bunların başında cinsiyet seçimi nedeniyle çok sayıda bebeğin doğmadan önce veya sonrasında hayatını kaybetmesi ve bunun yol açtığı toplumsal sorunlar yer alır. Son dekatlarda üreme tıbbı ve genetik dalında önemli gelişmeler olmuş ve bu sayede gebelikte cinsiyet seçiminin yapılabilmesi için gerekli olan embriyonun cinsiyet tayini gebeliğin daha erken döneminde, daha kolay ve güvenilir olarak yapılabilir hale gelmiştir. Sperm ayırma tekniklerinin etkinliğini ve güvenirliğini arttırmaya yönelik çalışmalar devam etmektedir. Bu makalede cinsiyeti belirlemede kullanılan sperm ayırma, in vitro fertilizasyon + preimplantasyon genetik tanı, invaziv olmayan prenatal tanı gibi yeni teknolojilerin tıbbi olmayan nedenlerle yapılan cinsiyet seçiminde kullanımı ve etik sonuçlarının tartışılması amaçlanmıştır.
Anahtar Kelimeler:

Tıbbi olmayan cinsiyet seçimi, etik, in vitro fertilizasyon, preimplantasyon genetik tanı, invaziv olmayan prenatal tanı, sperm ayırma

Non-medical Gender Selection: New Technologies-Technological Developments and Ethical Discussions

In order to have a baby of the desired gender, all kinds of medical or non-medical interventions which have taken during the period from pre-pregnancy to pregnancy, birth and postpartum period can be defined as gender selection. Gender selection can be made for medical or non-medical reasons. While gender selection for medical reasons is considered ethically appropriate, gender selection for non-medical reasons is generally not ethically approved due to undesirable medical and social consequences. Gender selection is often made in favor of men, thus while it increases gender discrimination also decreases the social value of women. Gender selection for non-medical reasons leads to many unfavorable medical, ethical and social consequences. The most important of these is the death of many babies before or after birth because of gender selection, and social problems it causes. In recent decades, there have been important developments in reproductive medicine and genetics, and thus, sex determination of the embryo, which is necessary for gender selection during pregnancy has become easier and more reliable at an earlier stage of pregnancy. Studies continue to increase the efficiency and reliability of sperm separation techniques. In this article, it is aimed to discuss the use of new technologies such as sperm separation, in vitro fertilization + preimplantation genetic diagnosis, non-invasive prenatal diagnosis used in sex determination, and the ethical consequences of gender selection for non-medical reasons.
Keywords:

Non-medical gender selection, ethics, in vitro fertilization, preimplantation genetic diagnosis, non-invasive prenatal diagnosis, sperm selection,

PDF

___

  • 1. Gölpınar S, Arda B. Tıbbi etik açısından: Doğum öncesinde cinsiyet belirlenmesi. Türkiye Klinikleri Tıp Etiği-Hukuk-Tarihi Dergisi 1995; 3 (2): 85-89.
  • 2. Koyun A, Örnek Büken N. Bir eşitlik ve yaşama hakkı ihlali: Cinsiyet seçimi. Journal of Human Sciences 2013; 10 (1): 34-46.
  • 3. George SM. Millions of missing girls: From fetal sexing to high technology sex selection in India. Prenat Diagn 2006; 26 (7): 604-609.
  • 4. Sen A. More Than 100 Million Women Are Missing. New York Review of Books 1990: 219-222.
  • 5. Hvistendahl M. Unnatural selection: Choosing boys over girls, and the consequences of a world full of men. Public Affairs, 2011.
  • 6. de Wert G, Dondorp W. Preconception sex selection for non-medical and intermediate reasons: Ethical reflections. Facts Views Vis Obgyn 2010; 2 (4): 267-277.
  • 7. Kalfoglou A, Scott J, Hudson K. Attitudes about preconception sex selection: A focus group study with Americans. Human reproduction 2008; 23 (12): 2731-2736.
  • 8. Walton DN. Slippery Slope Arguments. Oxford University Press, 1992: 566-568.
  • 9. Topçu E, Yalım NY. Preimplantasyon genetik tanının öjeniye ve insanın araçsallaştırılmasına yol açıp açmayacağının tıp etiği açısından yamaç aşağı kayma argümanı ile değerlendirilmesi. Türkiye Biyoetik Dergisi 2015; 2 (3): 187-201.
  • 10. Strong C. Can't you control your children? Am J Bioeth 2001; 1 (1): 12-13.
  • 11. Kalfoglou AL, Kammersell M, Philpott S, Dahl E. Ethical arguments for and against sperm sorting for non-medical sex selection: A review. Reprod Biomed Online 2013; 26 (3): 231-239.
  • 12. Zafran R. Non-medical sex selection by preimplantation genetic diagnosis: Reflections on Israeli law and practice. NCJL & Tech 2007; 9: 187.
  • 13. Serour GI, Dickens BM. Assisted reproduction developments in the Islamic world. Int J Gynaecol Obstet 2001; 74 (2): 187-193.
  • 14. Baldwin T. Understanding the opposition. Prenat Diagn 2006; 26 (7): 637-645.
  • 15. Sen G. Gender Biased Sex Selection. Geneva: Key Issues for Action Briefing Paper for WHO, 2009.
  • 16. Gupta MD. Selective discrimination against female children in rural Punjab, India. Population and development review 1987; 13 (1): 77-100.
  • 17. [UNFPA-İnternet]. Li S. Imbalanced sex ratio at birth and comprehensive intervention in China (Paper prepared for the 4th Asia and Pacific Conference on Sexual and Reproductive Health and Rights, Hyderabad, India). UNFPA, 2007. Erişim: (https://www.unfpa.org/sites/default/files/event-pdf/china.pdf). Erişim Tarihi: 25.03.2023.
  • 18. [ICRW-İnternet]. Pande R, Nanda P, Lee-Rife S. Postnatal discrimination against Indian girls: Severe stunting, 1992–2006 (International Center for Research on Women Fact Sheet #3). ICRW, 2009. Erişim: (https://idl-bnc-idrc.dspacedirect.org/bitstream/handle/10625/44952/131417.pdf?sequence=1&isAllowed=n). Erişim Tarihi: 25.03.2023.
  • 19. Chapman AR, Benn PA. Noninvasive prenatal testing for early sex identification: A few benefits and many concerns. Perspect Biol Med 2013; 56 (4): 530-547.
  • 20. [UNFPA-İnternet]. Guilmoto CZ Sex-ratio imbalances in Asia: Trends, consequences, and policy responses. UNFPA, 2005. Erişim: (https://www.unfpa.org/sites/default/files/resource-pdf/regional_analysis.pdf). Erişim Tarihi: 25.03.2023.
  • 21. Davis DS. Genetic dilemmas: Reproductive technology, parental choices, and children's futures. Oxford University Press, 2010.
  • 22. Macklin R. The ethics of sex selection and family balancing. Seminars in reproductive medicine 2010; 28 (4): 315-321.
  • 23. Robertson JA. Children of choice: freedom and the new reproductive technologies. Princeton University Press, 1994.
  • 24. van Balen F, Inhorn MC. Son preference, sex selection, and the "new" new reproductive technologies. Int J Health Serv 2003; 33 (2): 235-252.
  • 25. Robertson JA. Preconception gender selection. Am J Bioeth 2001; 1 (1): 2-9.
  • 26. Dahl E, Beutel M, Brosig B, Hinsch KD. Preconception sex selection for non-medical reasons: A representative survey from Germany. Hum Reprod 2003; 18 (10): 2231-2234.
  • 27. Oomman N, Ganatra BR. Sex selection: the systematic elimination of girls. Reprod Health Matters 2002; 10 (19): 184-188.
  • 28. Kudina O. Accounting for the moral significance of technology: Revisiting the case of non-medical sex selection. J Bioeth Inq 2019; 16 (1): 75-85.
  • 29. [MicroSort-İnternet]. Purity and Results. Erişim: (https: //www.microsort.com/results/). Erişim Tarihi: 08.02.2023.
  • 30. FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Recommendations on ethical issues in obstetrics and gynaecology sex selection. London: 1994.
  • 31. Ethical Issues in Obstetrics and Gynecology bay the FIGO Committee for the Study of Ethical Aspects of Human Reproduction and Women's Health. London: FIGO, 2015: 19-21.
  • 32. Guideline 017: Sex selection for nonmedical purposes. In: Chervenak FA ML, editor. FIGO Ethics and Professionalism Guidelines for Obstetrics and Gynecology London: ‎FIGO, 2021: 57-58.
  • 33. Ethics Committee of the American Society for Reproductive Medicine. Preconception gender selection for nonmedical reasons. Fertil Steril 2001; 75 (5): 861-864.
  • 34. Ethics Committee of the American Society for Reproductive Medicine. Use of reproductive technology for sex selection for nonmedical reasons. Fertility and Sterility 2015; 103 (6): 1418-1422.
  • 35. Use of reproductive technology for sex selection for nonmedical reasons: An Ethics Committee opinion. Fertility and Sterility 2022; 117 (4): 720-726.
  • 36. Milliez J. Sex selection for non-medical purposes. Reproductive BioMedicine Online 2007; 14: 114-117.
  • 37. Harper JC, Sengupta SB. Preimplantation genetic diagnosis: state of the art 2011. Hum Genet 2012; 131 (2): 175-86.
  • 38. The Ethics Committee of the American Society of Reproductive Medicine. Sex selection and preimplantation genetic diagnosis. Fertil Steril 1999; 72 (4): 595-598.
  • 39. Malpani A, Malpani A, Modi D. Preimplantation sex selection for family balancing in India. Human reproduction 2002; 17 (1): 11-2.
  • 40. Parikh F. Sex-selection by IVF: Detrimental to Indian women. Issues Med Ethics 1998; 6 (2): 55.
  • 41. ACOG Committee Opinion No. 360: Sex selection. Obstet Gynecol 2007; 109 (2 Pt 1): 475-478.
  • 42. Bouffard C, Viville S, Knoppers BM. Genetic diagnosis of embryos: clear explanation, not rhetoric, is needed. CMAJ 2009; 181 (6-7): 387-391.
  • 43. Pessach N, Glasser S, Soskolne V, Barash A, Lerner-Geva L. The Israeli National Committee for sex selection by pre-implantation genetic diagnosis: A novel approach (2005-2011). Isr J Health Policy Res 2014; 3 (1): 33.
  • 44. [GenderSelect-İnternet]. Methods of gender selection. Erişim: (http: //chooseagender.com/Methods-Of-Gender-Selection.aspx). Erişim Tarihi: 02.09.2022.
  • 45. Miller BD. Female-selective abortion in Asia: Patterns, policies, and debates. Am Anthropol 2001; 103 (4): 1083-1095.
  • 46. Hsiao C, Wang H, Hsieh C, Hsu J. Fetal gender screening by ultrasound at 11 to 13+ 6 weeks. Acta obstetricia et gynecologica Scandinavica 2008; 87 (1): 8-13.
  • 47. Efrat Z, Akinfenwa OO, Nicolaides KH. First-trimester determination of fetal gender by ultrasound. Ultrasound Obstet Gynecol 1999; 13 (5): 305-307.
  • 48. Lo YM, Corbetta N, Chamberlain PF, Rai V, Sargent IL, Redman CW, et al. Presence of fetal DNA in maternal plasma and serum. Lancet 1997; 350 (9076): 485-487.
  • 49. [Erudit-BioéthiqueOnline-İnternet]. Haidar H, Dupras C, Ravitsky V. Non-invasive prenatal testing: Review of ethical, legal and social implications. 2016; 5. Erişim: (https://www.erudit.org/en/journals/bo/2016-v5-bo03553/1044264ar/). Erişim Tarihi: 25.03.2023.
  • 50. McCullough RM, Almasri EA, Guan X, Geis JA, Hicks SC, Mazloom AR, et al. Non-invasive prenatal chromosomal aneuploidy testing--clinical experience: 100,000 clinical samples. PLoS One 2014; 9 (10): e109173.
  • 51. Colmant C, Morin-Surroca M, Fuchs F, Fernandez H, Senat M-V. Non-invasive prenatal testing for fetal sex determination: is ultrasound still relevant? European Journal of Obstetrics & Gynecology and Reproductive Biology 2013; 171 (2): 197-204.
  • 52. Koumbaris G, Kypri E, Tsangaras K, Achilleos A, Mina P, Neofytou M, et al. Cell-Free DNA Analysis of Targeted Genomic Regions in Maternal Plasma for Non-Invasive Prenatal Testing of Trisomy 21, Trisomy 18, Trisomy 13, and Fetal Sex. Clin Chem 2016; 62 (6): 848-855.
  • 53. World Health Organization (WHO). Preventing gender-biased sex selection: An interagency statement-OHCHR, UNFPA, UNICEF, UN Women and WHO. WHO, 2011.
  • 54. Odeh M, Granin V, Kais M, Ophir E, Bornstein J. Sonographic fetal sex determination. Obstet Gynecol Surv 2009; 64 (1): 50-57.
  • 55. Has R, Topuz S, Yıldırım E, İbrahimoğlu L. Birinci trimesterde ultrasonla fetal cinsiyet tayini. Türkiye Klinikleri Jinekoloji ve Obstetrik Dergisi 2002; 12: 228-231.
  • 56. Ergin RN, Yayla M. Birinci trimester ultrasonografisinde cinsiyet tayini doğruluk yüzdesi. Perinatal Journal/Perinatoloji Dergisi 2014; 22 (2): 74-78.
  • 57. Genetik Hastalıklar Tanı Merkezleri Yönetmeliği. Resmi Gazete, Tarih: 10.06.1998, Sayı: 23368.
  • 58. Wikler D, Wikler NJ. Turkey-baster babies: The demedicalization of artificial insemination. Milbank Q 1991; 69 (1): 5-40.
  • 59. Benn PA, Chapman AR. Ethical challenges in providing noninvasive prenatal diagnosis. Curr Opin Obstet Gynecol 2010; 22 (2): 128-134.
  • 60. Hall S, Reid E, Marteau TM. Attitudes towards sex selection for non-medical reasons: A review. Prenat Diagn 2006; 26 (7): 619-626.
  • 61. Verbeek P-P. Toward a theory of technological mediation. Technoscience and postphenomenology: The Manhattan papers 2015;189.
  • 62. Van Hoof W, Pennings G, De Sutter P. Cross-border reproductive care for law evasion: A qualitative study into the experiences and moral perspectives of French women who go to Belgium for treatment with donor sperm. Social Science & Medicine 2015; 124: 391-397.
  • 63. Baruch S, Kaufman D, Hudson KL. Genetic testing of embryos: practices and perspectives of US in vitro fertilization clinics. Fertil Steril 2008; 89 (5): 1053-1058.
  • 64. Levy N. Against sex selection. South Med J 2007; 100 (1): 107-9; discussion 10-11.
  • 65. Manchanda S, Saikia B, Gupta N, Chowdhary S, Puliyel JM. Sex ratio at birth in India, its relation to birth order, sex of previous children and use of indigenous medicine. PloS one 2011; 6 (6): e20097.
  • 66. Sahni M, Verma N, Narula D, Varghese RM, Sreenivas V, Puliyel JM. Missing girls in India: infanticide, feticide and made-to-order pregnancies? Insights from hospital-based sex-ratio-at-birth over the last century. PLoS One 2008; 3 (5): e2224.
  • 67. Keysers L. Where are the missing Chinese girls? Newsl Womens Glob Netw Reprod Rights 1991 (36): 15.
  • 68. Garg S, Nath A. Female feticide in India: issues and concerns. J Postgrad Med 2008; 54 (4): 276-279.
  • 69. George S, Abel R, Miller BD. Female infanticide in rural South India. Economic and political weekly 1992: 1153-1156.
  • 70. Missmer SA, Jain T. Preimplantation sex selection demand and preferences among infertility patients in Midwestern United States. Journal of Assisted Reproduction and Genetics 2007; 24: 451-457.
  • 71. Ahmad Al-Akour N, Khassawneh M, Khader Y, Dahl E. Sex preference and interest in preconception sex selection: A survey among pregnant women in the north of Jordan. Hum Reprod 2009; 24 (7): 1665-1669.
Türkiye Biyoetik Dergisi-Cover
  • ISSN: 2148-5917
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2014
  • Yayıncı: Türkiye Biyoetik Derneği
Arşiv
Sayıdaki Diğer Makaleler

Mental Hastalığı Olan Bireylere Karşı Klinisyenlerin (Tıp Öğrencileri) Tutum Ölçeğinin (MICA 2) Türkçe Versiyonu Psikometrik Özellikleri

Murat AKSU, Semra AY

Meme Kanseri Hastalarının Tanı ve Tedavi Sürecinde Yaşadıkları Zorlukların İncelenmesi: Pilot Çalışma

Şükran PEKER, Bengisu Pınar ACAT, Bedirhan KAHRAMAN, Habat Allah KHASAWNEH, Lina ELMUGHRABİ, Ali ALJUBORİ, Seyhan HIDIROĞLU, Gürkan SERT

Tıbbi Olmayan Cinsiyet Seçimi: Yeni Teknolojiler – Teknolojik Gelişmeler ve Etik Tartışmalar

Sebahat ATAR, Serap ŞAHİNOĞLU

Yad Ellerin Klinik Diş Hekimliği El Kitabı

Süleyman DİLEK

Yaşamın Son Döneminde Tıbbi Tedavi ve Bakıma İlişkin Karar Verme Süreci: Türkiye ve Almanya Örnekleri Üzerinden Karşılaştırmalı Bir Değerlendirme

Setenay Sinefin BAŞAR