Medical technology is advancing at an accelerated rate, repeatedly creating gaps between the amazing abilities that it provides us on the one hand and public opinion concerning authorization and public consensus to employ these abilities, on the other hand. We remember the huge uproar and ardent debate in Israel and throughout the world surrounding the birth of the sheep “Dolly” through cloning. A sudden, primeval fear arose with respect to the future Orwellian world in which cloned humanoids will fill the streets. The human race touched the throne of the Creator, and at the same time was filled with fear and trepidation. It is therefore not surprising that many societies, including Israel, took advance measures to protect themselves through quick legislation aimed at arresting this terrifying, if groundless, vision.

We must currently address a supposedly “easier” issue: not intervening in the act of creation from its inception, “only” determining in advance, by request, the offspring’s sex, as the technology for “pre-implantation genetic diagnosis” is already available in several medical centers in Israel. However, is this authorized? Will we allow experts in this technology to act freely based on their professional ability, when in doing so we are crossing the line of fundamental values of human society? It should be noted that the technology for sex determination has been applied for several years, with widespread public support, in order to prevent sex-chromosome linked genetic diseases. However, any deviation from this narrow policy carries the danger of bringing us closer to distant places such as India and China, for example. There, fetuses are killed for financial and social reasons during the first months of pregnancy, after their sex is known, upsetting the demographic balance in these countries.

The Ministry of Health recently published guidelines that permit choosing the sex of the fetus for non-medical reasons. According to these guidelines, permission will only be granted to married couples that have four joint children of the same sex and for whom the birth of another child of the same sex will constitute an insufferable emotional burden to the point of “fundamental and significant damage to their mental health”.

At a meeting of the IMA Ethics Bureau on the issue, the members weighed the fundamental values of personal freedom and the individual’s natural right to determine how he will lead his life, versus the good of society as a whole and the fundamental values on which it is based. Considering this fragile balance, and not straying from the ethical positions of large medical organizations in the Western world, the Ethics Bureau members decided that choosing the sex of the fetus is only permitted, ethically, for medical reasons. Nevertheless, the Bureau members found it appropriate to limit this decision, on an exceptional basis, to a specified period of five years. At the end of this period, the position will be brought before the Ethics Bureau for reevaluation.

Position Paper

• The fast pace of medical technological capabilities requires reevaluation of society’s fundamental values on a regular basis.
• Pre-implantation genetic diagnosis currently enables choosing the sex of the fetus in advance and diagnosing the existence of genetic diseases.
• In-vitro fertilization performed for the purpose of genetic diagnosis exposes the woman to medical procedures that cause suffering and carry a health risk and should therefore be employed only for a worthy purpose.
• Choosing the sex of the fetus is a worthy purpose when performed to prevent severe genetic diseases.
• Choosing the sex of the fetus through in-vitro fertilization for social, financial or religious reasons is not a worthy purpose and is therefore ethically wrong.
• This decision is limited to a period of five years. At the end of this period, it will be necessary to reexamine scientific capabilities to choose the sex of a fetus, the long-term effects of this technology on the newborn and the position of society and the legislature on this issue.