21 October 2013
ByAppeared in BioNews 727
After hearing about an event listed on the BioNews website, last month, I went to a 'café scientifique' hosted by the Canadian Institutes for Health Research.
The topic for analysis at this particular event was the human egg trade in Canada, which, like in most developed nations, is a booming business. For me, this extremely interesting evening shed light on many of the ongoing ethical concerns that seem to torment parties engaged in this field.
In particular, legal regulation surrounding the benefits that one can receive from participating in an egg donation in Canada are relatively unclear. In fact, it's pretty darn murky. From what I understand, the Canadian Assisted Human Reproduction Act 2004 offers ambiguous guidance in relation to the levels of compensation that egg donors may receive. Aside from standard, arguably foreseeable expenses such as train rides to and from the clinic or concrete childcare costs for having to hire a babysitter whilst you donate, the Act appears silent on the reimbursement for more indirect expenses. This might include the cost of having to take a week off work if the donor falls ill after donating, for example.
The law does nonetheless state that it is illegal for Canadians to buy eggs. However, in an attempt not to stigmatise the women who may have been involved in such a process, there is no outright declaration that it is illegal for women to sell their eggs. This has arguably driven, or at least encouraged, women to travel to other countries such as the USA and sell their eggs there instead, where they can make up to tens of thousands of dollars without the fear of prosecution upon return. Inconsistent, right?
We see ambiguities played out elsewhere too. The Canadian Medical Association Journal has recently reported that an insurer has denied coverage to a Canadian fertility doctor facing a lawsuit by an American egg donor who claims that she suffered a stroke after her egg retrieval. The insurance company claims that because his practice contravened the Assisted Reproduction Act by using a foreign broker to exchange money outside of the country for eggs retrieved locally, he thereby invalidated the terms of his insurance.
The other main issue that resonated with me was the fact that the safety of the women who make the very admirable decision to donate does not appear to be a central concern within this multi-million-pound industry. Although donors, in the vast majority of cases, willingly enter into agreements to donate their eggs, one has to challenge the assumption that such women are able to truly provide clinics with their consent when the full medical implications of agreeing to donate have not yet been comprehensively assessed.
There are very few long-term studies on the effects of egg donation to women's physical and mental health and this is rather troubling. Two egg donors spoke at the event. One was a relatively young woman who, although not having any physical health problems, described the mental implications of donating and the frustration at not being able to reverse her decision to donate anonymously. An older woman, who had donated eggs more than 20 years ago, attributed the fact that she had acquired a form of cancer to her egg donations - something she was understandably aggrieved about.
It is worth noting that the egg donation industry is an overwhelmingly private one in Canada and so the incentives to monitor the continued health and wellbeing of the women who donate, and then go on to release any such research (be it good or bad), are perhaps less compelling for the profit-driven entities delivering the service.
Leaving the talk, armed with leftover appetizers and a stock of new pens, I got the impression that the Assisted Reproduction Act is in real need of reform to make it more relevant and responsive to the dynamics of the 'human egg trade' of today. It needs to unambiguously specify the acceptable circumstances for engaging with the egg trade via services in other countries, and needs clearer, tighter regulatory measures that put donor safety at its heart.