And The Right Price Is……..$1200

My last post was triggered in part by the then-impending announcement by the HFEA of adjustments to the monies provided to those who provide gametes in the UK.   Yesterday’s Guardian reports the result of the HFEA’s deliberations:  Egg donors will now receive compensation in the amount of 750 pounds (which is about $1200.)

It’s interesting to think about what the HFEA was trying to do here and it seems to me that the way it’s talked about is fundamentally different from how I’ve been thinking about it.   I’ve been talking about simple economics–if you offer more money, you get more sellers.   Here the government is fixing a price and trying to strike the right price to increase supply adequately.   The alternative–which exists in the US–is largely unregulated market where the ordinary laws of supply and demand set prices.

But the HFEA (and others quoted in the argument) see this quite differently.  They talk about trying to balance between altruism (which is the right reason to provide gametes) and more base motives–like financial greed or need.   From this perspective, you don’t want to offer too much money or you’ll get people acting for the wrong reason.  But you don’t want to deter the altruistic, since there are real hardships to providing gametes.   Consider this quote:

Professor Lisa Jardine, the HFEA’s chairman, denied that the £750 payment would induce people to donate eggs purely for money. “I find it very hard to see the £750 as an inducement,” she said. “I think it is a fair reflection of the effort and the time and the discomfort and the pain of some of it. I can’t see any room there for inducement.”

The concern about motives morphs into something slightly different later in the article:

Clare Lewis-Jones, chief executive of Infertility Network UK, said: “We hope that today’s announcement to increase the payment to donors will help encourage more people to become donors. The balance between coercing people to donate by offering large sums of money, and paying enough to ensure donors are compensated for their expenses and the wonderful gift they are giving is a fine one.”

The concern raised here–coercion–is one that resurfaces in other quotes.

Laura Witjens, chair of the National Gamete Donation Trust (NGDT), said: “No amount of money will ever repay what an egg donor does to help childless couples. This priceless gift changes lives and donors truly do it to help others. The NGDT believes that altruistic motives should remain at the core of donation and that payment, although intended as an expression of gratitude, should never facilitate coercion.

Now it seems to me that everyone agrees that altruism is good and is what they want to encourage.   But the countervailing concern seems to shift from bad motives (doing it for the money) to coercion and “coercion” seems an odd concept here.  Frankly, offering a lot of money for something doesn’t fit my general idea of coercion.   But I suppose the connection is that if you offer a lot of money and if women need money, then women will be compelled to take the offered money.     Thus, economic need is the instrument by which coercion becomes effective.  I think this rather strains the meaning of the language.

Apart from this, there’s a problem with the HFEA thinking.   Most of what I’ve read suggests that most women who become gamete donors–like most women who become surrogates–do so for mixed motives.   It’s pretty rare to see the wealthy in either group–which suggests that people who do not need money choose not to do these things.  But the women who provide eggs or become surrogates do seem (generally speaking) to be motivated in part by altruism as well as by an interest in the compensation.

This suggests to me that the HFEA’s careful balancing is based on a false assumption–that one acts for altruism or one acts for money but not for both.  If most women have mixed motivations then what becomes of the balancing?  When motivations are mixed no line can be drawn between altruism and financial need/desire.   And there’s no way of measuring whether you’ve done it right.  In time we will be able to tell how much the increased compensation affects the supply of eggs, but I’m not sure we’ll ever be able to tell

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14 responses to “And The Right Price Is……..$1200

  1. I couldn’t agree with you more. It’s an argument we always struggle to articulate here in the UK, where you are exactly right that there is an almost universally accepted assumption that any financial benefit completely eradicates people’s altruistic motives. There is also an, I think rather paternalistic, assumption that where money is offered women are unable to make sensible informed choices and their will is overborne. I don’t think that people’s reasons for donating or becoming a surrogate are ever that simple, or that black and white. I hope you don’t mind if I post your thoughts on our blog too in the UK.

    • Post away.

      I don’t really understand the assumption about how the money somehow deprives women of their ability to make choices. It’s as though women occupied some generally money-free space and suddenly the introduction of money is corrupting. Seems rather a throw-back to some Victorian image of the weaker sex if you ask me.

      Women are, of necessity, economic actors. They (we) must decide what we will do for work at what price. Women who are poor–and many women are poor–and/or women who have unmet financial needs must often contemplate doing distasteful or even dangerous work in order to secure money. Generally we accept that as a part of the life of any competent citizen. I’m not sure what makes this so different and I find the language of “corecion” particularly striking in that regard.

  2. I see it as an advanced society that is saying selling for profit vital components in the creation of a human being is unacceptable. Why are you not willing to look at it from this perspective?

    Taking away the profit aspect also keeps the vile bad people from taking advantage of women who have no say – no profit – no motive. There are those types of individuals in any market that brings the promise of a fast buck. The closest comparison to this market is adoption and we have so much proof of corruption and harm in it that we (society) don’t need to repeat the same mistakes in this.

    • I’m sorry if I have not been clear. I do see the general theoretical framework that might lead one to take what I’d call an anti-commodification stance. Indeed, I do that myself in some areas. So, for example, I think one should not commodify children, which is to say one should not buy/sell children. And this is what you allude to when you refer to the market for adoption, right?

      The problem, as I see it, is that the lines one ought to draw and not easy ones to draw and I think the HFEA’s pictures is grossly over-simplified. The pure way might be to say no money could change hands at all. That would avoid all commodification and leave only people who are purely altruistic. To be pure I think you’d need to rule out the provision of IVF in exchange for eggs, too–as that’s a form of compensation. But I think everyone sees that if we did that, there would be very few women providing eggs. (Of course, that result is fine with some people, too.)

      So there needs to be some compensation of some sort–and we’ll call it something like “reimbursement of expenses” in order to try to keep things clear. Some expenses are easy and clear–say you have to pay to park your car while you go to the provider. But there’s this huge murky area–the expenses for inconvenience, etc.

      In picking a number, the HFEA seems to be trying to do two things at once. On the one hand, it is trying to assure a decent supply of eggs. That’s a market oriented goal and it means setting the price at a point where supply will be adequate. On the other hand, it is trying to make some assessment of the expenses that can be reimbursed. But there’s no reason why that level of expenses will work in the market calculation, is there? So trying to do them both at once is simply mixing things up.

      I don’t really understand how setting low levels of compensation protects women. If you offer $1200 lots of women might turn you down but those who really need $1200 are still going to be sorely tempted. And of course they’ll only get $1200. Aren’t they worse off than if you offered $5000? If you offered $5000 you’d get more women tempted and those who went through with it would actually be paid more. Why is that so clearly worse?

      I don’t mean that we shouldn’t worry about unscrupulous players in this area, but I’m not convinced that capping the money women get paid addresses that concern.

  3. Ugh. what fake concern. Notice that no one suggested capping the fees received by the clinics and other parties involved.
    But of course, women can’t be trusted to know what’s good for them….

    • Excellent point/question. Why isn’t the focus on what the providers charge? it’s their quest for profit that leads them to perhaps take advantage of women–if/when women are taken advantage of here.

  4. (Is it just too logical and fairminded to suggest that organizations concerned about exploitation of women would set a MINIMUM pay instead of a maximum?????)

    • You know I wonder about this myself. Imagine a coal company saying that coal miners should be paid less because it’s dangerous work and we don’t want to tempt men to do that job, with all its risks and everything. Surely we’d see through that in a heartbeat.

  5. if you can sell your parts legally while concealing your identity and someone else can sell your parts legally to people whose identities are also concealed….your valuable. you can be stolen parted and sold to the highest bidder and your parents won’t even have the right to know who sold your body parts or who has parts of their daughters butchered body sewn into them. This is the reality under current regulations where the identity of donors and recipients is concealed and not dna confirmed. Look for yourself a the thousands of dead previously refrigerated bodies of girls all hollowed out missing their ovaries and organs all along the mexican border. Those girls had a market value and america is just the place to help capitalize on it. I’m sorry but if we allow people to profit from their body parts then they are putting a price on their heads

    • It seems to me that questions of anonymity/concealed identity really can be separated from concerns about commodification and market forces. (I’m not saying that this invalidates your point–there may be more reason to be concerned when they run together.) The women who will be providing eggs in the UK will all be identified for the recipients of the eggs. Thus the only question the HFEA is dealing with now is the money part.

  6. I’d like to see that confirmed by dna testing at retrieval, fertilization and prior to the implantation of the embryo, especially here in the US where there is private sector money to be made. Its not enough to point to a woman and say this woman agreed to donate she is who you chose and its her egg being fertilized by your husband and her embryo being implanted in you for gestation and delivery, its her offspring you will take home. Its easy enough for mix ups to occur but they are easy enough to prevent with a cheap dna test at each major milestone. You could catch a mix-up involving the egg of a patient or the sperm of a patient before fertilization or before implantation and require clinics to fix whatever led to the mix up or close their doors. Those same check points would make it difficult for scams where eggs and sperm of patients were used instead of those from the donors on their books because patient genes were obtained for free and they could represent they came from whatever donor was selected its not like the sperm and eggs have faces on them. But they do have a unique dna code. Checking that code and I think registering with the state as they do in europe but not here, will do much to reduce the incidece of error and graft.

    • It seems like what you want here is a good tracking system. I don’t know what sort of tracking they have in place in the UK so cannot assess whetehr it is good. I know a little bit about what they do at some clinics here in the US–clinics where patients expect to be using their own genetic materials. I think there are options that are less expensive and less technically complicated than the kind DNA-testing based system you are suggesting but that are quite effective.

      So with all that in mind, could we agree that what we want is an effective tracking system? Then the question becomes a more technical one–what is the best way to set up an effective tracking system? People who are deliberately scamming will avoid any tracking system, I fear. And while you may not care about the cost of a system, many people will–and so would prefer one that is 99% effective and a reasonable cost to one that is 99.5% effective and an much greater cost. (I don’t think any system can ever be 100% effective. There are always going to be errors.)

  7. we can agree

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