Heather Strange

The Ethics of Nonmedical Sex Selection

The aim of this paper is to demonstrate that there are significant ethical problems with nonmedical sex selection, and that prohibitive legislation is justified. The central argument put forward is that nonmedical sex selection is a sexist practice which promotes socially restrictive conceptions of sex, gender and family. Several steps are taken to justify this position: background information on technology and legislation is provided, the neoliberal position that is supportive of nonmedical sex selection is described, and preliminary reasons for rejecting this approach are given. A detailed description of how a harm/benefit based analysis contributes to the argument against nonmedical sex selection, and how it successfully counters most criticism, is provided. The paper concludes by suggesting that virtue ethics further strengthens the moral argument against nonmedical sex selection.

Non-medical sex selection: ethical issues

INTRODUCTION This paper aims to provide a concise review of the ethical issues that are commonly raised in the UK debate on non-medical sex selection. Background information on sex selection technologies is provided, as is a description of the relevant UK legislation. Arguments for and against non-medical sex selection will be explained and compared and conclusions will be drawn. It is finally suggested that the international debate on non-medical sex selection ought to be regarded as an important area of related interest. SOURCES OF DATA Data were obtained from a search of existing ethics and policy literature focusing on sex selection. AREAS OF AGREEMENT There are very few areas of universal agreement in the debate. AREAS OF CONTROVERSY There is much disagreement between critics over what harms are likely to be caused by sex selection and whether such harms are morally significant. The issue of whether governments can legitimately place limitations upon individual reproductive autonomy, and if so, to what degree, remains controversial.

A systematic review of information literacy programs in higher education: effects of faceto-face, online, and blended formats on student skills and views

Objective – Evidence from systematic reviews a decade ago suggested that face-to-face and online methods to provide information literacy training in universities were equally effective in terms of skills learnt, but there was a lack of robust comparative research. The objectives of this review were (1) to update these findings with the inclusion of more recent primary research; (2) to further enhance the summary of existing evidence by including studies of blended formats (with components of both online and face-to-face teaching) compared to single format education; and (3) to explore student views on the various formats employed. Methods – Authors searched seven databases along with a range of supplementary search methods to identify comparative research studies, dated January 1995 to October 2016, exploring skill outcomes for students enrolled in higher education programs. There were 33 studies included, of which 19 also contained comparative data on student views. Where feasible, meta-analyses were carried out to provide summary estimates of skills development and a thematic analysis was completed to identify student views across the different formats. Results – A large majority of studies (27 of 33; 82%) found no statistically significant difference between formats in skills outcomes for students. Of 13 studies that could be included in a meta-analysis, the standardized mean difference (SMD) between skill test results for face-to-face versus online formats was -0.01 (95% confidence interval -0.28 to 0.26). Of ten studies comparing blended to single delivery format, seven (70%) found no statistically significant difference between formats, and the remaining studies had mixed outcomes. From the limited evidence available across all studies, there is a potential dichotomy between outcomes measured via skill test and assignment (course work) which is worthy of further investigation. The thematic analysis of student views found no preference in relation to format on a range of measures in 14 of 19 studies (74%). The remainder identified that students perceived advantages and disadvantages for each format but had no overall preference. Conclusions – There is compelling evidence that information literacy training is effective and well received across a range of delivery formats. Further research looking at blended versus single format methods, and the time implications for each, as well as comparing assignment to skill test outcomes would be valuable. Future studies should adopt a methodologically robust design (such as the randomized controlled trial) with a large student population and validated outcome measures.

P3-67 Patient and professional experiences with non-invasive prenatal diagnosis (NIPD) and testing (NIPT): social and ethical issues raised

OBJECTIVES: A Robertsonian translocation is a whole arm exchange between two acrocentric chromosomes (human chromosomes 13, 14, 15, 21, and 22) resulting in a fused chromosome with 2 long arms. Individuals with Robertsonian translocations have a loss of 2 of the 10 p arms of the acrocentric chromosomes. This is the most common chromosomal translocation, occurring at a frequency of ~1 in 1000. Robertsonian translocation carriers have a higher risk of infertility, miscarriages, and aneuploid offspring. Female carriers of the 14:21 translocation have an estimated risk of fetal trisomy 21 of 15% in any given pregnancy. METHODS: We have developed Digital Analysis of Selected Regions (DANSR) assays targeting sequences that are common to the p arms of the five acrocentric chromosomes. DANSR products were hybridized onto a custom manufactured DNA microarray for DNA analysis. The Fetal-Fraction Optimized Risk of Trisomy Evaluation (FORTE) algorithm allows one to account for both the fetal and maternal fractions in the cell free DNA sample to determine Robertsonian risk. The expectation in a Robertsonian sample is that, in the maternal fraction of the cfDNA, the DANSR assays on the five acrocentric p arms should have a concentration that is 20% less than the controls. RESULTS: 24 samples (15 Robertsonian, 9 control) were evaluated for Robertsonian translocation. FORTE analysis successfully identified the Robertsonian translocations in all 15 Robertsonian samples. CONCLUSIONS: As Robertsonian translocations are the most common chromosomal translocation found in humans and can have significant reproductive consequences, a screen for Robertsonian translocations would provide women valuable information regarding their risk for fetal trisomy. With the FORTE algorithm this analysis can be accurately carried out on cfDNA from pregnant women.Objectives: The aim of this study is to gain a rich understanding of early experiences with emerging non-invasive prenatal diagnosis (NIPD) and non-invasive prenatal testing (NIPT) testing technologies. The study aims to identify issues of common interest and concern to both patients and professionals located in a wide variety of settings. Methods: This qualitative PhD study is based on data gathered through a total of forty-three in-depth (narrative) interviews with patients and professionals in the UK. Twenty-three experts with direct professional experience of NIPD or NIPT (including scientists, fetal medicine consultants, policy makers and genetic counsellors) were interviewed, along with ten patients with direct experience of NIPD or NIPT, and ten parents with more general experience of prenatal screening or diagnosis. Clinicians involved in both the NHS-based provision of NIPD and the private provision of NIPT participated in the study. The interviews yielded a rich and diverse dataset, and were analysed for crosscutting themes. Results: A number of core themes were identified as being of significance across the data set. These included: test accuracy; the boundary between NIPD and NIPT; the boundary between ‘high risk’ and ‘low risk’ populations; hopes around NIPT as a possible replacement technology; anxieties around the possible routinisation of selective termination; tensions between the aims of public health screening programmes and individualised care. Conclusions: The rapid development of NIPD and NIPT has very quickly given rise to a diverse and rich set of patient and professional experiences. The issues of interest and concern identified within patient and professional accounts of this new testing technology present a complex ethical, legal, political and social landscape. Knowledge of these early experiences with NIPD and NIPT may enable a better understanding of the advantages these tests may offer, as well as practical and ethical problems that are likely to arise in future, as both NIPD and NIPT become further embedded in specialist clinical practice and routine prenatal care.

Biobanking Across Borders: The Challenges of Harmonisation

The development of national initiatives in biobanking in countries such as Iceland, Estonia, and the UK, has given rise to a great deal of social, legal and ethical discussion over the past decade and more.