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