Money, Money, Money

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.

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2 responses to “Money, Money, Money

  1. In Australia we have altruistic donation only (for local donors). You are right that this has created a shortage and has resulted in the importation of gametes from places that have different regulatory structures than we have. For example eggs can be imported from countries with anonymity, whereas we only have ID Release here these days.

    However I don’t think this is a reason to give up on the idea of altruistic donation. In Australia recipients can chose a local donor knowing that they gave altruistically, or choose an overseas donor knowing that they received payment. There are other differences that come into this decision. Local donors usually provide only limited information. Overseas sperm quality is often higher.

    However we still have the capacity to regulate by extension. We have family limits here and so sperm donors can only be used up to those family limits. Although there have been quite a few documented examples where those family limits have not been well observed, that doesn’t alter the fact that we are imposing OUR regulations on the market and that sperm doesn’t just flow freely across the border in an unstoppable tide. The implementation is a bit rough but it’s there and will only get stronger over time.

    I find it very interesting that when alternative recruitment strategies have been used in shortage situations (UK), there has been a strong response. I believe that if local clinics had to stop using commercially imported gametes they would find creative ways to recruit local donors and maintain our regulatory regime: ID Release, altruistic donation and family limits.

    • It seems fair to assume that thinking about gametes and the whole process of ART in different ways might change who participates and what participation means. I suppose what I mean to say is that our attitudes towards ART (and the resulting regulation of ART) is all socially constructed. There’s nothing fixed about it.

      As it happens, at least here in the US, it has been shaped by the medical and commercial enterprises that dominate the field. I’m not saying this is bad or good, but it is worth keeping in mind. It’s possible to imagine rethinking what we’re doing, drawing on different pools of people, generating different regulatory schemes, that perhaps put other priorities ahead of those that tend to predominate.

      That’s one reason why the experience in other countries is particularly interesting. Other countries have made other choices and you can tell a bit about how those play out.

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