My last post reintroduced questions about the role of money in ART and, perhaps most specifically, in the use of third-party gametes. This has really been a recurrent theme on the blog and it’s good to come back to it from time to time.
It also comes up in the news with some regularity. Here’s a recent story from Australia. It’s not exactly clear to me that this is news per se–I mean, I don’t see that anything is actually happening around the matter. It’s really a discussion piece. And it raises (albeit briefly) a number of the points that make the whole question of money complicated.
If there is no compensation at all for egg/sperm providers or for surrogates, you won’t entirely eliminate those practices, but you will severely restrict them. You may also end up creating an even-less-regulated underground economy.
If policies around this vary country to country (as is indeed the case) you end up creating reproductive tourism. Now your own citizens will be going to other countries where all sorts of trouble might arise.
All of which means there are pragmatic reasons why the “no compensation of any kind” position might be a hard sell. (Note that the pragmatic arguments are quite apart from arguments about the entitlement of individuals to make free choices about their own bodies, etc.)
If you start down the compensation path, however, you hit this raft of new questions. You might wish to avoid the idea that you are buying selling children or even buying eggs/sperm from providers. (I have to say, I’m not sure you can avoid the impression that you are selling eggs/sperm. I haven’t seen any way to describe that transaction except as a purchase of gametes.)
So you can structure compensation so that it is for time/trouble rather than for the product, say. (And here I think I’d distinguish sharply between surrogacy and providing gametes for reasons which I have discussed elsewhere–I don’t think I can discuss them in the same way. From here on out, I’m just going to muse about gametes.)
But even if you do that, there are a host of difficult questions. Can you offer too much money? Many people worry that you can and I have to say that I am really troubled by that worry. Why is it okay to offer a woman $5000 for her eggs but not $15,000? We know that some women will provide eggs for $5000. Those women will be better off with $15,000 surely. But there are also some women who won’t provide eggs for $5000 but might for $15,000. Are we especially worried about those women? Why should we be more worried about them then we were about the women who would provide eggs for $5000?
I’m a bit cynical about what’s really going on here. I wonder if people are more worried because women from a more privileged class–women wo we might care more about–might become interested in being egg providers.
Then there are concerns about eugenics and pricing structures. These are driven in part by market dynamics that will arise if you allow compensation. Members of some racial/ethnic/cultural groups are less inclined t0 be egg providers and so there are fewer of those eggs. But there may still–there is still–demand for them, because most people who want third-party gametes do want gametes from people who look like them. So there might be a premium for people from those groups to provide eggs. Is that bad? Why? (The premium here would accrue to non-white providers, if that matters.)
Beyond that, though, there are more problematic questions about eugenics. Other traits that people want to pay for are things like height and weight. I’ve never seen ads for short/heavy providers, but I’ve seen quite a few for tall/thin ones. What can we say/do about that? If you allow people to shop for gametes, how can you stop them from shopping for these sorts of characteristics?
I’m just running through the issues that crop up really to try to collect them all in one place. I don’t think there are easy answers, but there’s certainly a lot to worrry about.