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You are here: MEDICA Portal. Magazine & More. MEDICA Magazine. Topic of the Month. Volume archives. Our Topics in 2010. September 2010: Medicine in the womb. Blood.

Who sets ethical boundaries?

Who sets ethical boundaries?

Photo: Baby shoes presented in rose on a hand

Through directed manipulation during pregnancy, an American physician wants to exert a normalizing influence on future sexual preferences of embryos. This case was recently discussed in the American news magazine Time and shows what type of bizarre fruits the currently booming prenatal medicine bears. Secretly and completely unregulated, ethical boundaries are evidently overstepped on an unimaginable scale.

What exactly is this now public case all about? It is about the phenomenon of – the actually not so uncommon – androgen insensitivity syndrome (AIS), a genetically based failure of the cortisone synthesis, which among other things leads to an excess of male hormones. Girls with AIS are born with a masculine outer genital, called a clitoral hyperplasia, because during embryonic development they were exposed to increased androgen concentrations. Traditionally with this type of intersexuality, after birth a surgical “circumcision“ is performed – a practice which is controversial and afterward perceived as a forced treatment by many affected people.

Not allowed and still practiced for years

For many years and more or less publically, another therapy approach has been practiced: Suspecting that the fetus might develop androgen insensitivity syndrome due to the genetic makeup of the parents, pregnant women get treated with Dexmethasone, a synthetic glucocorticoid. The idea is to keep the hormonal environment where the female fetus is growing, free from large androgen concentrations. Even though this prenatal treatment indeed favors the development of definite feminine genitals, the relation of benefits and risk of this intervention is more than questionable.

There is one single controlled long-term study using a very small number of cases, and its results are highly alarming. Administering Dexmethasone during pregnancy appears to be linked to a risk of mental development disorders. And another critical point is this: You need to start very early with the corticoid treatment – at a point in time where neither the sex of the child is known nor the question of whether the newborn really would actually be afflicted by AIS can be answered. This means, you act at random with the consequence, that in many cases healthy fetuses are exposed to the highly effective synthetic hormones. In male fetuses this manipulation can verifiably lead to disruptions in genital development.

Despite the risks, the highly speculative character and though it is not even allowed, prenatal Dexmethasone treatment is practiced on a large scale if AIS is suspected, and presented to the parents not as an experimental but an established treatment. This fact alone contradicts all medical-ethical conventions.

Dexmethasone makes a better woman

When somebody now presumes the right to normatively influence the sexual orientation in the embryonic stage, this type of omnipotence delusion sends cold shivers down one’s spine. Omissions by Doctor Maria New, who today works at the renowned Mount Sinai Medical Center in New York, are hair-raising: Not only does she want to prevent that AIS girls later become lesbians by using Dexmethasone, this prenatal intervention actually is supposed to make them into better women with an adequate interest in childbearing for example. One can get very frightened at the thought that this physician was able to work unhindered for so many years.

Thanks to the large dedication of several female bioethicists, the New-case now has been made public. The American public health authority FDA wants to institute a testing method –now, after the prenatal Dexmethasone therapy has been practiced for almost 20 years. There is concern that this case is merely the tip of the iceberg and that secretly also other questionable prenatal therapy experiments are being conducted. This is why working ethical control mechanisms are so important to protect the interests of parents and especially those of unborn children.

Ulrike Viegener


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