Few things can get people's dander up more than throwing reproduction and money into the controversial vessel of the female body and mixing well. News that some clinics in England are seeking ovum donations in exchange for discounted fertility treatments has cracked open an old controversy about the ethics of women getting compensated for donating their eggs.
According to an Associated Press story, the program is offering half-price fertility treatments in exchange for a woman's donating half her eggs, and is modeled on other egg-sharing arrangements between fertile and infertile women. Some feminists oppose any financial incentives for donating eggs to science because the practice may lead to the exploitation of poor women. Using words like "impoverished" and "desperate" to describe these donors, critics paint a picture that isn't so far from poor Chinese peasants hawking their kidneys on the black market. On the flip side, reproductive rights activists suggest that women 1) can make up their own minds and 2) need incentives to donate eggs to science (since doing so requires that they endure invasive medical procedures and a substantial claim on their time and energy).
But behind this painstaking separation of ethical and unethical egg donations simmers a larger issue about what egg donation actually is. Is donating an egg to science like contributing to other medical research -- in which participants are allowed to be compensated? Or is it like organ donation -- a process too dangerous to be tainted by monetary transactions? Or is it like sperm donation writ large? (In other words, if producing eggs were men's work, would society expect them to do it without just compensation for their pains?) Or maybe (if you believe "The Baby Business" author Debora Spar that "we are selling children") egg donation is a bit like a shrinky dink version of human trafficking.
The globe seems split on the issue. Most industrialized nations prohibit paying donors, so many of the egg donations in the West come from American women. Even within the U.S., state laws vary. Arizona banned donor payments last year, but many other states don't regulate them at all.
Some laws seem only to convolute the issue. In California, for instance, it's legal for a woman to be paid to donate her eggs. (According to a USA Today story last year, some get more than $10,000 for their efforts.) But if a woman chooses to undergo the same process for the purposes of donating her eggs to science, then the law limits the compensation to covering her expenses. What's the difference? According to the AP story, ethicists and legislators are drawing a distinction between the benefits. The benefits of creating a child are a "known good." (I love my kids, but from a societal point of view this is debatable.) Stem cell research, in contrast, has an unknown outcome, so women shouldn't be tempted to subject themselves to the medical risks of fertility drugs, ovarian simulation and harvesting to pay back student loans.
Call me obtuse, but there's something weird about this logic. According to a story in Nature last year, there are still questions about the long-term health risks for women who undergo fertility treatments (for both donors and infertile would-be mothers), so the concern over safety seems to be a valid one. But if fertility treatments have potential long-term health repercussions, shouldn't we be concerned about all of the millions of women lining up at fertility clinics around the world? Why is subjecting a woman who has been paid for her eggs to medical risks crossing an ethical line, when we applaud women who have done it for free or to give birth to their own babies? Shouldn't our concern extend to all women at risk? What's also vexing about the hand-wringing over women donating eggs (in exchange for fertility treatments) is that it pretends to be on the side of the "poor woman" when in fact it simply strips her of a choice accessible to her affluent sisters. In the end, I can't help thinking the controversy over donating eggs for science has the taint of moralizing, simply because it involves a woman's reproductive system instead of, say, her brain or her legs. If the procedure is deemed safe enough for affluent women to pay for, then it seems paternalistic at best to assume women who can't afford fertility treatments are unable make the same informed choices.
On the other hand, if these increasingly common fertility treatments turn out to be rotten with risk (and researchers say we may not know for a couple of decades), it will be one dark day at the hatchery.