Comments  11

• Tuhin Bakshi 7 Feb, 09:18 PM

  One should not be judgmental before talking to the patient discussing and finding her reason for US and hence the sex of the child. It can be entirely due to her curiosity, to arrange the decor of the room for the unborn child to plan for the family affairs. We should not and cannot jump into the conclusion that the patient wants it to abort the child based on the news media. We may get a surprise after talking. So a meeting with an open,informative and non judgmental discussion with the patient is the first step. If it comes out that she is asking it for aborting due to the sex of the unborn child, well, then you have to tell the fact that we do not find the sex of the child for the purpose of aborting, period!

• Dr Julian Vanderpol (R1) 7 Feb, 11:16 PM

  A very interesting issue. I would advise my colleague the following:
  
  To my patients I would say:
  
  In Alberta, fetal sex is not reported on obstetrical ultrasounds as it is not generally medically relevant. For this reason, I cannot get an ultrasound to specifically report the fetal sex. Ultrasound technicians will sometimes reveal the fetal sex at the parents’ request, but due to recent controversy about sex-selective abortions, many are now refusing to reveal fetal gender. Other options would include commercially available 3D ultrasound which can determine fetal gender in the second trimester (www.ucbaby.ca). As well, there are also commercially available urine tests that reportedly can determine fetal gender as early as 6-7 weeks gestation (www.gendermaker.com).
  
  In principle I would say:
  
  There are currently no legal restrictions on abortion in Canada – i.e. abortions are legal for any and all reasons. Interestingly, there are legal restrictions on embryo gender selection during IVF (the Canadian Assisted Human Reproduction Act, 2004). In the absence of legal restrictions, one would look for ethical statements from provincial colleges and medical associations for direction. The only formal statement I am aware of is from the College of Physicians and Surgeons of BC, which says sex-selective abortion is “socially repugnant, and it is unethical for physicians to facilitate such action” (https://www.cpsbc.ca/files/u1/Fetal-Sex-Determination.pdf). If one was a physician in BC, this could reasonably be interpreted to mean that before suggesting other avenues to determine fetal gender, a physician should first determine that the parent(s) are not pursuing this with a sex-selective abortion in mind, as that would be facilitating their action. However, the CPSA has thus far not made a similar statement I am aware of. No ethical direction from the AMA or CMA has been forthcoming yet either – discussion has remained peripheral. Therefore in the absence of legal restriction and ethical statements, I would default to the patient’s autonomy and provide information about commercial available methods of fetal gender determination without further questioning.
  
  Since it appears the vast majority of the Canadian public does not approve of sex-selective abortion, several Canadian bio-ethicists have proposed health professionals not reveal fetal gender until past 30 weeks gestation, after which abortion is difficult or impossible to obtain (http://www.sogc.org/jogc/abstracts/full/201001_HealthPolicy_1.pdf, http://www.cmaj.ca/content/early/2012/01/16/cmaj.109-4091.full.pdf). I don’t think this policy should be adopted or advocated by the colleges or medical associations, as it is unlikely to be effective in reducing sex-selective abortion when commercial methods of fetal gender determination are readily available. The medical community would in essence be washing its hands of the matter without addressing the ethical question of whether sex-selective abortion is OK. And if not, why not, and what should we do about it?
  That is the real question physicians, ethicists, law-makers, and the public need to ask themselves. And it brings up other questions. If we are comfortable aborting fetuses with Down syndrome or other genetic abnormalities, why does sex-selective abortion seem wrong? Is it discrimination? If fetuses in Canada are legally not considered human, how can they have human rights, including the right to not be discriminated against based on gender? If they were considered human, wouldn’t the right to live be more pressing than the right to not be discriminated against? (The SOGC and CMAJ editor Rajendra Kale have stated that sex-selective abortion is discrimination against women, see http://www.sogc.org/guidelines/documents/guiJOGC198PS0711.pdf, http://www.cmaj.ca/content/early/2012/01/16/cmaj.120021.full.pdf). Why is it that fetuses are not legally considered human, but newborns are? R. vs Morgentaler (1988) removed that from the law, and no legal status has been legislated since. Canada remains the only Western country with no legal restrictions on abortion. Does something in the baby change in the moment of birth, such that it should now be entitled the right to live, the right to not be discriminated against, and every other human right? If so, what changes? If not, does this transformation occur earlier in gestation? Is it when the fetus becomes ‘viable’? Is it when the heart starts beating on its’ own? If so, should gestation limits on abortion be pursued, in keeping with other Western countries? Might this transformation even occur at conception? What would that mean?
  
  Surely deciding whether fetuses are human or not is a topic worthy of debate (http://www.theglobeandmail.com/news/politics/ottawa-notebook/tory-mp-fuels-abortion-debate-with-call-to-revisit-rights-of-unborn-law/article2279143/).
  
  I know what I think. I would challenge physicians and all Canadians to decide what they really think.
  

• Dr. Lang 8 Feb, 09:36 AM

  In the scenario described there is suspicion and no direct evidence of intent. Good communication may help resolve the apparent dilemma. The question is, as I see it, what does that look like? That is what I would ask my colleague and perhaps other sources like the college as it appears that if there is a real problem it may be generalized. I can imagine a number of different strategies and I would like to know I had support before taking unilateral action. For example, disclosing to the couple the controversy that exists and its rationale as well as your expectations of yourself and those others may have of you may be all that is needed to initiate meaningful dialogue that leads to options for resolution.

• Dr. Dolgetta, R1 6 Mar, 04:29 PM

  Like many ethical issues, there is a distinction between what is morally permissible versus what is legally permissible. Often the two align quite nicely, but sometimes, as in this case, they do not. The question then becomes what ought we to do in the face of a legal right which seems morally repugnant? Surely abortion for the purpose of sex-selection seems morally repugnant. It is borne of the oppression of women and perpetuates that very oppression. In fact, in most countries where females are routinely aborted or left to die upon birth, the very thought of the equality of men and women is laughable. In our culture, that equality is presumed in a woman's legal right to abort her fetus for whatever reason. While Dr. Vanderpol raises important and thought-provoking questions, whether or not the fetus is in fact a person is irrelevant in the face of the competing rights of a woman to bodily self-determination versus the potential rights of a potential person. So, while we may find abortion for sex-selection morally repugnant, I do not believe we can deny the right of a woman to have an abortion without taking a step backwards in the overall equality of women. This may seem counterintuitive to some, but ethical analyses often are - at least prima facie.
  
  My ongoing thought is that we need to tackle the issue from its origins, that is - we need to confront the social forces which lead to such "choices" to begin with. Also, as some food for thought, in many of the cultures where the birth of females is discouraged, it is not uncommon for a woman who gives birth to a female to be maltreated and abused alongside her new daughter. While her decision to abort may not be a fully free choice, it may be the best choice in that it spares her and her unborn daughter of much suffering.

• David Richards 6 Mar, 08:54 PM

  I believe women have the right to abortion on demand, providing it is within safety guidelines, which would include aborting a fetus on many grounds including gender. Perhaps after several boys one wants a girl, perhaps social pressure is in favour of one gender, and so on.I do not believe a doctor has the right to withhold information from a patient at any stage and I believe it is reprehensible to do so. I also believe that a doctor cannot be compelled to act against his beliefs. It is not our responsibility to educate patients about morality and I would consider it arrogant to attempt to do so. As for the question, there is a decidedly racist tone to it.

• Baljinder Mann 7 Mar, 07:35 AM

  I would like to explore the reason as to why this patient wants to know the sex of her baby. Maybe she just wants to do proper shopping and get the baby's room ready.
  
  Usually even in cultures where sex selection/termination is reported as per media, if it is the very first pregnancy, I think the parents are just curious as to what their baby will be, a boy or girl. When the couple has one or two daughters, then I start wondering what they could be thinking and I would just ask clearly the reason why they want to know and counsel them that this kind of service is not available and why not.

• Dr. Elizabeth L. Schick, MD, CCFP 7 Mar, 08:06 AM

  We have no ethical, legal nor moral right to force a woman to bear a child she does not want. Some parents prefer males, some prefer females, and some simply want a healthy baby. In addition, every child has a right to be wanted and needs to be wanted by the family that raises him/her. If a family does not want a child of a certain sex, that child will not be provided with the necessary emotional, mental and physical support that he/she needs to grow up normally. Why would we want to put a child at risk of neglect? I would tell her the sex of the child and ask the woman if there were any hereditary diseases she was worried about and if she said "no" I'd leave it at that. In any case, any woman can go to the USA and pay to get an ultrasound to find out the fetus's sex.
  

• Madhavan Das 7 Mar, 11:19 AM

  Very diverse but valid lines of logic. I could identify the points to ponder as follows: (1) Parents / mother has the right to knowledge about fetus,(2) doctors have the duty to inform as accurately as possible, (3) Fetus is human; and if human rights are important in Canada ethically and legally who will advocate for the rights of the mute fetus, (4) discrimination in any form turns the civilisation clock backwards, (5) Level of selection of 'breed' is essential in the future- we are dreaming about ' genetically 'creating' perfect human beings. How could we enforce parents the additional burden of a deformed fetus ( which will be later aburden to healthcare system and economy at large.
  (6) If the mother already has same gender children, couldn't she opt for the different gender ? (8) If sex determined for aborting fetus on cultural or religious reasons, why not charge the parents heavily ( generates money and discourages practice ! ) (9) We better have a national consensus based on ethics and values since Canada will be looked up at by many other nations.

• Wesley Steed MD 8 Mar, 06:39 AM

  I have always thought that the abortion has been an ethical vacuum in Canada. We allow it not because it there is anything inherently ethical about it but because it has and does exist, in a way like tobacco and alcohol , both allowable poisons. If abortion is ok for convenience reasons why would it be wrong for sex selection (just another reason of convenience).

• John Fernandes 30 Mar, 05:34 PM

  This is really a question about whether abortion is right or wrong. Neither side will ever be "right" and it therefore needs to be left to be an individual issue of morality rather than a public issue of policy.
  
  The reasons for abortion may vary greatly from medical need to social need - and nobody but the individual has the right to say whether or not an abortion is needed.
  
  A much larger crime than abortion is the removal of somebody's personal liberty and freedoms. I don't believe that anybody or any law has the right to remove somebody's personal liberties.
  
  Keeping requested available information from somebody - like the gender of their fetus - is too "Nanny state" and is a bigger crime against personal liberty than any perceived threat of what an individual might do with such information.

• P Kam 13 Apr, 01:41 AM

  I think it sounds ambiguous if one time a physician allows abortion (regardless of sex preference) based on mother's request and then the next time questions about moral of sex selective abortion. To me, it is about abortion. Abortion of male fetus does not make it sound more moral than abortion of female fetus.
  
  I will give it back to each individual to decide their own moral/value, unless it is regulated by law.
  
  As for the mother, she has the right to get the information.
  
  And I think , there is always place for counselling/consultation.