A little while back I wrote about concerns that we overpay women who provide eggs for ART. (I’m trying to steer clear of calling them “donors” since getting paid isn’t exactly consistent with “donating” the eggs.) In a nutshell, I don’t think that’s the right question to ask at all. You can go read that earlier post for the argument I offered.
Here’s an article from today’s New York Times that raises precisely this issue yet again. The article notes that the American Society for Reproductive Medicine (ASRM) guideline’s set a maximum payment of $10,000. (This is set out in voluntary guidelines.) But a quarter of the ads surveyed by one researcher offered amounts in excess of $10,000. Some offered as much as $50,000.
The concern expressed by Dr. Aaron Levine, who is the author of the study quoted in the article, is that women will choose to provide eggs against their best interests. The more I think about this the more it’s bothering me.
The article actually raises a variety fo concerns. Some seem legitimate to me. For example, Dr. Levine suggests that some of the ads for high compensation are probably a form of bait-and-switch. That’s clearly a bad practice: A species of false advertising and unacceptable. And there’s some concern about whether women are properly informed of the risks involved in egg donation. Again, I think that’s a reasonable thing to worry about.
But as I said before, I don’t really see the concern about how much women are paid being legitimate. If it is risky and painful to provide eggs for ART, then shouldn’t the women who do this be well-paid? How can you argue that because it is dangerous a person should be paid less? We do not generally cap the salaries of people who do dangerous work on the grounds that it is dangerous.
As I think about it, the expressed concern about compensation troubles me in two ways. First, the premise seems to be that women will be so dazzled by numbers with lots of zeros that they’ll lose the capacity to make intelligent choices. I choose to think better of women than this. It seems to me simply condescending to say this.
Second, go and look at that article. It seems to me the real concern is that the wrong women are being tempted–fine young college women who are bright and intelligent. If you cap the money at $10,000 those women will be sensible and won’t offer their eggs. Problem solved.
But other women will offer their eggs for $10,000–women who aren’t lucky enough to be at Princeton or Yale, women who might need money for rent or to put food on the table. Shouldn’t we be just as worried about these women? And if we go down that path, than we shouldn’t be paying anyone for eggs.
I can understand this position–that we shouldn’t pay women for eggs at all. I don’t agree with it, but it seems to me to be a position of some integrity. But if all you’re worried about how much women are getting paid, then I think something else–something not nearly so principled–is going on.
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So what do you think is going on?
Possibly trying to make it more affordable for infertile couples?
I am more inclined to think that arguments like this stem from two things–sloppy thinking and elitism–and then a general uneasiness with the very idea that we permit the purchase and sale of gametes.
The concern expressed here is that very high prices draw these well-educated and rather privileged women into the trade. But there seems to me no recognition that lower prices will still draw women into the trade–just a different class of women. That lack of recognition might be because folks aren’t thinking it through. Or it might be because folks aren’t as concerned with those other women–only with the privileged ones discussed in the article.
Beyond that, I recognize that the general position that gametes can be bought/sold is controversial. I’ve written about it in the past. https://julieshapiro.wordpress.com/2010/03/22/notes-on-the-canadian-egg-trade/ I think many people are uneasy with the practice.
I think it’s more useful to have that basic conversation on the propriety of selling gametes at all.
I would expect that the so-called “privileged” donors have an educational background which, when coupled with a psychological evaluation and a legal consultation, have had their enthusiasm to donate tempered or at minimum reined in. I do not believe these women are unwitting victims of the trade.
I also take the article to task for suggesting that women are victimized during the informed consent provided by the IVF doctors. The suggestion amounts to doctors knowingly committing medical malpractice. I do not accept that as a conclusion worthy of consideration.
Very thoughtful article, as always, Professor Shapiro. Much like you, I have struggled for a while to reconcile my conflicting beliefs on this issue. At the heart of the matter is my strong conviction that we must allow compensated “donation”, lest we deprive those suffering from infertility with an opportunity to have a child. So I think we both find ourselves reflexively and reactively defending the concept, yet mired in some very objectionable practices that seem to be systemic and unavoidable.
With that said, I do believe there are ways to allay the concerns of those who are legitimately concerned about the ethical shortcomings of this industry without proscribing compensated egg donation entirely. As I have written about before, it begins and ends with the fertility clinics. The American Society of Reproductive Medicine Guidelines can eliminate much of what is objectionable about this industry. But because they are guidelines and have no teeth behind them, they are habitually ignored by agencies and medical facilities.
The fertility clinics need to be the gatekeepers. If they merely asked, as part of the clearance process, for the attorneys representing the Recipients and Donors to include within their clearance letters a representation that the ASRM Guidelines have been complied with, we could effectively put an end to the improper solicitation and compensation to egg donors. Simultaneously, if the ASRM would begin revoking the memberships of physicians who proceed with donor cycles in violation of the organization’s guidelines, we would see an immediate and dramatic improvement in this industry.
Julie – Your thoughts on this are great. I truly believe that those who are embarking upon egg donation for the right reasons are informed and know what they are getting into. However, those who are only seeing dollar signs I feel would donate other organs for money without educating themselves, or paying attention to the education presented to them. And yes, lots of those ads for egg donors are bait and switch type ads. The biggest issue we have right now is not how much egg donors are being compensated. It’s that anyone and I mean ANYONE can hang a shingle outside their business, call themselves an egg donation agency and open up shop. I am not sure if there is an easy answer. We are supposed to self regulate but we don’t. I don’t want the government stepping in and telling us what we can and we can’t do but I am scratching my head at some of the practices I see happening as well.
Robert you are clearly not a health professional. All of us who work in the field know what a myth informed consent is. At least in the poor people’s facilities that I’ve work in.
I think the issues around consent are quite complicated and surely worthy of a post of their own. I promise, soon. In the meantime, perhaps we can agree that the degree to which those offering their gametes are properly informed probably varies. Marna’s comment above would offer one reason for this–just about anyone can set up shop.
But I don’t think that informed consent is necessarily a myth. It’s quite possible for responsible health practitioners to explain risks and give people time to digest the information. And I have some basic faith in the capacity of people to make their own choices in this area, as in many others.
It’s possible but government, regulatory agencies, protocols create a climate that fosters against a true partnership between providers and patients. Nurses like me are the exception not the norm. Excuse me for bragging. Rich people may get it, poor people don’t unless they know enough to raise a big fuss.
It wouldn’t surprise me at all to find that that more privileged people (and I’d measure privilege in a number of different ways, including money but also education, perhaps) feel more entitled to ask questions and refuse consent than do those who have not had lives of privilege. And obviously language barriers and illiteracy would make obtaining meaningful consent much more difficult. In a perfect world, those charged with ensuring/obtaining consent would have tools to help them overcome at least some of this. But I know the world isn’t perfect.
There’s a more troubling factor, too. If the person charged with getting the consent derives income, directly or indirectly, from succeeding in getting the consent, then it seems to me it would be very difficult for the person to really remain totally neutral as they provide counsel a patient about whether or not to consent. To be concrete, if you work for a place that makes its money offering eggs for sale, it seems to me you have an undeniable interest in getting people to provide you with those eggs. If you are also charged with helping the potential sellers make their decisions about whether or not to sell, I think you could clearly have a conflict of interest.
All this said, I don’t think these problems are insurmountable. Perhaps this is just a statement of faith but I believe that people can make meaningful decisions about their lives, even if they are relatively poor people. But there is much to be wary of.
They double talk- create legislation requiring one thing, and another legislation that makes it so you can’t do it.