7 November 2006
Researcher in Medical Ethics, Imperial College, London
Appeared in BioNews 383Recent media reports describe the case of Alexandra Saunders, a 25 year old woman who has been advertising her eggs for sale on the Internet in the hopes of paying off her credit card debts . The tone of these reports has largely been incredulous if not overtly condemnatory. But why should this be the case?
The uncomfortable truth is that reproductive technology and embryo research have between them created a market in those hitherto most sacrosanct of tissues: sperm, eggs and embryos. Much agonising takes place over whether we should allow the commodification of our bodies. These debates frequently take place in the arena of organ donation. The UK prides itself on the dissociation between filthy lucre and healthcare (hence perhaps our ailing, cash-strapped NHS). Payments for bodily commodities are not countenanced, and such practices are regarded as being the heinous province of less ethically-enlightened countries.
But this squeamishness in relation to money and biological commodities may in itself bring about some ethically dubious results. Some clinics here openly advertise their services in facilitating egg procurement from other countries, where -one might assume- the protections in place might be far below what they could be here. The reasons for the greater willingness of foreign women to donate remain unspecified in the adverts, but the possibility of financial incentives certainly springs to mind.
Other, still more open markets in gametes operate in our fertility clinics. Many clinics suffered a deficit in sperm after the change in the law in April 2005, allowing children born from donated gametes to trace their donor parent after the age of 18. Some clinics were wise enough to foresee this deficit, and to brief donors in advance so that their stocks did not diminish to the same extent as those of less resourceful clinics. The result? The clinics lacking in stored sperm are obliged to buy in sperm from elsewhere. So sperm is clearly already a commodity with a market value which is being bought and sold around the country.
But what do the donors themselves get? Nothing to speak of. Yet the clinics with surplus supplies are now profiting from this now-scarce resource. In fact, everyone who has an interest in this commodity seems to profit apart from the donors themselves. Perhaps we need to face the possibility that in the UK, our strict ethical policies on refusing to countenance payments for gametes are disadvantaging the very people that we think we are protecting.
Laura Witjens, a spokesman for the National Gamete Donation Trust is quoted as saying in response to Ms Saunders' plan to sell her eggs online, that more women should be willing to donate altruistically. But why should they? Women who donate eggs undergo a gruelling regimen of drugs, followed by a surgically invasive harvesting procedure. These interventions are not risk-free: several women have died from the side-effects of the drugs involved. Witjens rightly says that women who donate solely for money put their health at risk. But women who donate altruistically also put their health at risk - and get nothing in return!
Many clinics recommend that female patients who require egg donation become pro-active in their search for donors. Friends and family members are regarded as being good potential sources who will require no payment. But do we really think that women sought out by desperate friends and relatives as potential donors are more objective, more realistic, less coerced than those who make the decision primarily for financial reasons? I don't mean here to belittle the sacrifice made by altruistic donors. But I think we kid ourselves if we think that somehow coercion is not at issue here simply because money is not involved.
This problem of coercion also arises in the context of 'egg-sharing', a means by which women can currently 'pay' for fertility treatment by 'sharing' their eggs with other infertile women (or, in some cases, by donating eggs for research). Guido Penning in a previous BioNews commentary suggests that some women's drive to have a child results in their agreeing to egg-sharing despite serious misgivings. The point here is that coercion is an issue whether or not it is cash which is the incentive. We allow other incentives to operate in the market place for gametes in the UK, but have denied that there is such a market.
These denials tend to centre round a distaste for commodification, and concern for the wellbeing of donors. However, I suggest that since commodification is rife, we consider whether we are really protecting donors or our own sensibilities. As soon as we admit that there is a market for gametes, we open the possibility of regulating it, of ensuring fair prices, and of reducing the likelihood that people will go abroad for unregulated services where the scope for exploitation is even greater.
Finally, there is of course a broader ethical issue here. The procurement of gametes is hedged about with taboos, two of the strongest of these being masturbation, and the violation of bodily integrity. Technology has enabled us not only to covet, but to obtain our neighbours' gametes. Is doing so ethically acceptable? This is the question at the heart of our unease about egg donation, but it has been eclipsed in a prudish scramble to pretend that at least we are not paying for doing so.