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A 'social compensation tax' for social sexing

11 April 2005
Appeared in BioNews 303
The recommendations of the recent report by the House of Commons Science and Technology Committee in the UK have stirred up the discussion on social sex selection. Over the years, the discussion on sex selection has been seriously hampered by the high emotional engagement of the participants. As a consequence, counter arguments are not taken seriously and possible solutions are rejected off hand. Most counter arguments can be refuted or sidestepped by creative solutions. A biased sex ratio for instance can be prevented by introducing the framework of family balancing. Another major argument by opponents is that social sexing, at least at present, implies the use of medical means for a non-medical goal. This use may be wrong for two reasons: misallocation of financial resources meant for public health and wastage of medical capacity.

The first point is easily avoided by making people who desire to use social sexing pay out of their own pockets. The fact that only people able to pay can use the technology is ethically irrelevant. Equal access is required by the principle of justice but this principle only applies to basic health care services, i.e., treatments needed for a reasonable level of well-being. The opponents of social sexing have to choose: either the desire for a child of a specific sex is reasonable and then equal access is required, or the desire is unreasonable and then no discrimination is involved when access is restricted to people who have the financial means.

However, even when no money is taken from the health care budget, there may still be inappropriate use of public funds. Not only the direct costs (who pays for the service) but also the indirect costs (who pays for the steps that make the service possible) should be taken into account. In states with a heavily subsidised educational system, each professional has a social role to fulfil. It is a loss to society if a physician whose education is largely paid for by the community invests most of his or her time, expertise and energy providing elective medical services. This loss should be compensated. The most obvious way to do this is by imposing a 'social compensation tax'. This tax should be in proportion to the time, infrastructure, personnel etc. specifically invested in social sexing. This implies that the tax should be significantly higher for sex selection by means of IVF combined with PGD (preimplantation genetic diagnosis) (IVF-PGD) than for sexing by sperm sorting (supposing of course that IVF-PGD is not needed already for medical reasons).

The tax should a) compensate society for the loss of health care capacity, b) compensate the community for the money spend on the education of physicians, and c) reduce the number of applications and as such diminish damage to the health care system. The same strategy of financial penalties is applied for other socially undesirable activities like smoking. Moreover, the amount collected by the tax could be used to support people who need PGD for medical reasons.

In this way, possible damage to the reputation of a technology, due to the application for social sexing, could at least be diminished. The wrong of inappropriately using health care capacity is transformed into a right, i.e., enabling people to use expensive techniques (especially in the case of rare genetic diseases). Although direct reciprocity should not be the rule (the money could be transferred to the general health care system), a direct link between elective applications of a technique and medical applications makes the transformation more visible. Whatever the solution, the complexity of sex selection for social reasons is not done justice by an outright prohibition.

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