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Tempest in a Womb: What's Wrong With Preventing (Or Promoting) Homosexuality In Utero?

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Gay rights advocates have for many years advanced the case, quite persuasively, that sexual orientation is largely biologically determined. The political advantage of such a position is clear: If sexual orientation reflects an intrinsic attribute like skin pigmentation, rather than merely a form of chosen conduct, then arguing that homosexuals should stop being gay is no more reasonable than arguing that African-Americans should stop being black. Suddenly, however, advocates for gay equality find themselves confronting a thorny offshoot of biologically-based theories of sexual orientation. As technological advances unravel some of the factors that shape sexual identity, the potential will inevitably arise to reverse the forces that make some of us gay and others of us straight. A recent debate in the fields of bioethics surrounding novel treatments for an uncommon genetic disorder has raised a question that may soon confront parents more generally: Is it ethical to attempt to predetermine the sexual orientation of one's children? And should such intervention even be legal? Several leading progressive writers have condemned the prospect of tampering with biological destiny in this way. However, as a lifelong supporter of gay rights and a vocal critic of conventional notions of sexuality, I am convinced that such parental choice, if it ever becomes technologically possible on a mass scale, will actually prove socially beneficial.

The specific controversy that has provoked this larger debate involves an experimental treatment for congenital adrenal hyperplasia (CAH), a heterogenous group of recessive genetic syndromes in which females often have "masculinized" or "intersex" external genitalia. Treatment with a corticosteroid, dexamethasone, in utero, appears to reduce significantly the incidence of such ambiguous parts. However, the two leading proponents of this approach, endocrinologist Maria New of Mount Sinai Hospital and psychologist Heino Meyer-Bahlburg of Columbia University have come under attack in recent weeks for another possible consequence of such therapy: reducing the number of CAH patients who grow up to be lesbian or bisexual. (Those readers interested in the physiology should read "Sexual Orientation in Women with Classical or Non-Classical Congenital Adrenal Hyperplasia as a Function of Degree of Prenatal Androgen Excess," an article published by Meyer-Bahlburg, et al, in the Archives of Sexual Behavior in 2008) For the sake of full disclosure, I should note that while I also practice medicine at Mount Sinai, I have never interacted with Dr. New.

In a column titled "Preventing Homosexuality (and Uppity Women) in the Womb?" that appeared in The Hastings Center's prestigious Bioethics Forum in June, three prominent thinkers on sexuality -- Alice Dreger of Northwestern University's Feinberg School of Medicine, American University's Ellen Feder and Anne Tamar-Mattis of Advocates for Informed Choice -- lambasted Meyer-Bahlburg and New for the social implications of their work. They wrote: "

While everyone has been busy watching geneticists at the frontier of the brave new world, none of us seem to have noticed what some pediatricians are up to. Perhaps it is because so many people are fascinated by the idea of a 'gay gene' that prenatal 'lesbian hormones' have slipped past public scrutiny. In any case,...activists for gay and lesbian rights should be wary of believing that claims for the innateness of homosexuality will lead to liberation."

Instead, the authors raise the unwelcome specter of such technology being used to straighten gay fetuses prior to birth.

What is not intuitively clear is why some couples choosing not to have gay babies is harmful for society or for the babies themselves. I should emphasize that this is not a choice that I would make personally. But presumably many of the prospective parents who would make such a choice are precisely the variety of deeply-prejudiced individuals likely to mistreat or disown homosexual offspring. No gay or lesbian child would ever want such a parent. So allowing some bigoted parents to choose against gay kids -- even encouraging them to do so -- would reduce the number of gays and lesbians who suffer through horrific upbringings, or end up running away from home, or committing suicide. Letting anti-gay parents produce straight kids would ensure that more children were wanted children and fewer suffered abuse. Needless to say, the technology would have to be foolproof for the benefit to outweigh the harm, because otherwise an anti-gay parent might occasionally end up with a gay child despite opting against one -- and that poor kid would face an even greater struggle for familial acceptance. But as a utilitarian ethicist concerned with preventing human suffering, and as a gay rights advocate who cares particularly about preventing suffering because of anti-gay prejudice, I would much prefer that a child be born straight than that she endure the pains of parental rejection.

Of course, all parents who choose to have straight babies need not be bigots. Another set of prospective parents, who are not themselves prejudiced, might none-the-less prefer heterosexual progeny because they believe that straight children face fewer social barriers, and less discrimination, than gay children. These couples might well support gay rights. They simply do not want the revolution for gay equality mounted on the backs on their own sons and daughters. "In an ideal world, I wouldn't care whether my child was straight or gay," such a parent might state. "But in the real world, I want to shelter my child from as much pain as possible." While I do not share that sentiment, I can envision a well-intentioned and liberal-minded person harboring such a view.

The assumption of critics, of course, is that parental choice will be used primarily to prevent homosexuality. This is not intuitive. Instead, the identical technology could be used to promote homosexuality as well. In the same way that African-American or Catholic couples pass traditions down to their children, gay couples might choose to have gay children in order to pass culture along from generation to generation. Obviously, many gay couples, like many straight couples, will not care whether their children love members of the same or opposite sexes. On the other hand, one can certainly imagine a veteran gay rights activist preferring a gay son or daughter to continue the struggle. Since all children will be born with a sexual orientation of some sort, and since none is inherently preferable to any other, it is hard for me to understand why this choice would be ethically objectionable.

The primary problem with efforts to turn adult gays and lesbians straight, whether conducted by psychiatrists like Robert Spitzer or religious fanatics like Exodus International, is that it does not work. Instead, such "therapeutic" charades merely increase the suffering of people who should be encouraged to embrace their identities rather than fighting futilely to change them. In contrast, hormonal therapies in utero might someday prove effective at actually altering identities. Today's science fiction has a long track record of becoming tomorrow's scientific fact.

I do not mean to endorse the specifics of dexamethasone therapy for CAH babies, which is controversial for multiple reasons. What I do wish to propose is that one of the principal concerns raised by the implications of such research -- allowing parents to choose their children's sexual orientation someday -- is not the evil that critics fear. I have long argued that our society is far too tolerant of prejudice against gays and lesbians. If Joseph Ratzinger said of Blacks or Jews what he says of homosexuals, he would rapidly find himself as acceptable to civil society as David Duke or David Irving. Bigots should not get a pass just because they wear vestments. However, the way to combat homophobia is not to deny parents the opportunity to have the sort of children they desire -- no matter how misguided their motives. What seems lost to critics of such choice is that the future will likely bring both new technology and social equality. By the time parents can safely choose the sexual orientation of their children, I suspect few of them will actually want to do so.

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