I just came acrossthis essay in Al Jazeera (English). It’s an opinion piece by Donna Dickenson, who is described as an Emeritus Professor of Medical Ethics and Humanities at the University of London.
The piece is a short overview of law (and pending law) in India, the UK and France regarding ART. Unsurprisingly, given the qualifications of the author, it focusses on the ethical/moral issues. Because it is a rather short piece it hardly gives them full consideration, but it’s a nice place to start thinking.
The main underlying concerns Professor Dickenson identifies seem to be about possible exploitation and commodification. (“Commodification” is what you do when you turn something into a commodity that is bought and sold. It isn’t necessarily a terrible thing–the commodification of excess garden produce, for instance, seems okay to me. But it obviously depends on what you are commodifying. Commodification of human organs is generally thought to be a bad idea and the commodification of children is even worse.)
There are linkages between commodification concerns and exploitation concerns, so it isn’t surprising that they arise together. But there are also important differences. If your main concern is exploitation then I think you can consider guarding against exploitation by ensuring various procedures are in place. So, for instance, if I worry about the exploitation of gamete donors, I might put in place various counselling requirements. Counselling requirements won’t do anything about commodification problems, however. To address commodification you might prohibit the exchange of money in transactions.
In general in the context of ART, where money is offered to participants (and I’m thinking here of gamete donors and/or surrogates) you will see concerns about both exploitation and commodification. To some degree it seems that the more money is at stake, the more you might worry, although as I’ve said in the past, I don’t understand the concern that we overpay people. Even small sums of money will tempt those who are impoverished and have no alternative sources of income (think surrogates in India). Offering greater sums of money just increases the pool of people who are tempted. If tempting is in and of itself wrong, than it should be wrong to tempt anyone, especially those who are poor and vulnerable.
I share Professor Dickenson’s skepticism that the labels we attach to the money (compensation vs. reimbursement for expenses) helps address any of these concerns. Surely anyone who really thinks about the commodification argument will not be long delayed by this rhetorical move.
It’s also striking to me that people may attach those same concerns (commodification/exploitation) to different practices. What I mean is that many people are concerned about commodification/exploitation with respect to the sale of gametes, but not everyone is. (I’m not terribly concerned about this, though I do believe that virtually every commercial transaction presents a risk of exploitation.) At the same time, other people (and here you might count me in) are concerned about commodification/exploitation with regard to surrogacy. And to round out the picture, it’s probably worth noting that some will have the concerns about both practices and others about neither.
I suppose this means that it is worth thinking carefully about how commodification/exploitation concerns operate generally and then, perhaps, to try to apply them consistently across the field. I don’t mean that this needs to yield uniform acceptance or rejection. It seems to me that surrogacy and use of third-party gametes are very different practices and so a consistent analysis could yield different conclusions. Still, being a general fan of consistency, I think it is worth trying to make the analysis consistent.