About one in every 1,000 children is born severely hearing impaired; more than half of these are a result of a genetic mutation.

Let's say there's a medical test one could use to identify a fetus or embryo that would become a hearing- impaired child. Such a test would allow parents the option of selecting only pregnancies that would result in a child with normal hearing.

This sort of testing is part of our attempt to select the healthiest children we can – a thought some find objectionable. Some consider it an extension of the eugenics movement – selecting babies that are as close to perfect as possible.

When non-deaf pregnant women were surveyed, a large majority reported they would want screening for a deafness gene although only 5 percent would terminate their pregnancy if deafness was known to be present.

There's another side to this issue. Let's say hearing-impaired parents want to use the same medical test to select a "deaf embryo."

The couple feels they are entitled to have deaf children. They explain that they do not see deafness as a disability, but rather a culture that they want to share with their children. They want to give birth only to a child who is hearing impaired.

Are these equivalent requests?

Such complex issues will play out more and more in the years to come. Is this gene or embryo selection a process that we want to leave to parents to decide, or should there be rules that govern embryo selection?

These decisions affect the child, the parents and society.

When the parents select the hearing-impaired status of a child, the system is respecting their reproductive autonomy; they get to choose the attributes of their child so long as they do not harm their child.

But is it in the best interest of the child to be born without hearing? How far can we go? Does this mean that people should be entitled to bring into existence any kind of children they wish?

Of course, the child has no choice – he or she will get a chance to live the best life possible given his or her genes. But society will need to accept this child and provide for the child's special needs, which may require extra expenses.

The clash then is between the interest of the parents – to have the child they want – and that of society, which has to provide for a child with special needs.

Should parents be able to select a deaf child if they wish?

Tell us what you think at drwilkes@sacbee.com.

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Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Reach him at drwilkes@sacbee.com.

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