Background

Medical technology is advancing so rapidly that there is often a gap between its remarkable capabilities and the public’s stance on authorization and broad societal consent for its use. This is evident from the massive uproar and intense debate surrounding the birth of the cloned sheep "Dolly." Suddenly, there was a primal fear of a dystopian future where humanoids filled the streets. Humanity had touched the creator's throne on one hand, and on the other, it was filled with fear and awe. It is not surprising, therefore, that many societies, including Israel, hastened to protect themselves with swift legislation aimed at halting such frightening visions, even if they were fundamentally implausible.

We are now faced with a seemingly "easier" issue: not intervening in the act of creation from its inception, but "only" determining, upon request, the sex of the fetus. The technology for "pre-implantation genetic diagnosis" is already available at several medical centers in the country. But is this authority granted? Should we allow experts to act freely according to their professional capabilities while crossing fundamental societal values? It is important to clarify that technology for determining the sex of the fetus has been in use for several years, with broad societal consent, to prevent genetic diseases linked to gender chromosomes. Any deviation from this restrictive policy might lead us to extreme scenarios, such as those in China and India, where fetuses are aborted in the early months of pregnancy upon learning their gender, due to economic or social reasons, thereby violating the demographic balance in those countries.

The Ministry of Health recently published guidelines allowing the selection of the gender of the fetus for non-medical reasons. According to these guidelines, permission will be granted only to married couples who have four children of the same gender, and having another child of the same gender would cause them unbearable psychological distress amounting to "significant and substantial harm to their mental health."

In a discussion held by the Ethics Office, the fundamental values of individual freedom and the natural right to decide how one’s life should proceed were weighed against the overall good of society and the fundamental values it rests upon. In this delicate balance, the Ethics Office members, concluded like the ethical positions of major medical organizations in the Western world, that selecting the gender of the fetus is ethically permissible only for medical reasons. However, they found it appropriate to limit this decision exceptionally to a period of five years. After this period, this position will be reviewed.

Position Paper

• The rapid advancement in medical technology necessitates ongoing re-evaluation of fundamental societal values.
• Pre-implantation genetic diagnosis now allows for the determination of the fetus’s gender and the identification of genetic diseases.
• In vitro fertilization, used for genetic diagnosis, exposes the woman to medical treatments involving suffering and health risks and should therefore be used only for appropriate purposes.
• Selecting the gender of the fetus is ethically permissible when it is done to prevent severe genetic diseases.
• Selecting the gender of the fetus through in vitro fertilization for purely social, economic, or religious reasons is considered ethically inappropriate and should only be allowed in extreme cases, subject to the
  examination of individual circumstances and in accordance with state guidelines.
   

Due to the rapid progress in genetic diagnosis, there is a need to periodically review the scientific capabilities of gender determination, its long-term effects on the newborn, and societal and legislative stances on this issue.