I’ve been thinking a lot about the role of money in ART recently, as is evidenced by the recent post on the topic. (Even the last post on embryos could be tied in here as you can think about what happens if we permit the purchase/sale of embryos as we do gametes.) Today I wanted to pull a bit back from ART and think about the role of money more generally.
There are some things that people will do whether they are paid or not–things that people find rewarding in and of themselves. Thus, I’ll work in my garden without any financial incentive to do so. But there are actually many things that people do that they do largely for money–by which I mean that their dominant motivation is getting money even if they also have other motivations. For most people, this is probably a fair description of their income-earning work. (Very few people are lucky enough to be paid for something they would choose to be doing even if they weren’t paid.)
In general the fact that you are being paid to do something you wouldn’t otherwise be doing doesn’t bother us. But there are times when we do worry about this and some interesting problems arise.
Think, for example, about human subject research. People are often paid to be subjects. They are paid because we understand that even though a few altruistic individuals might agree to be subjects, experiments that require people to take time and effort and perhaps even experience discomfort and pain and incur risks won’t attract enough volunteers in the absence of some compensation.
It seems fairly clear to me that the greater the compensation, the greater the number of potential subjects you’ll have to work with and choose from. It’s also true that the greater the compensation, the wider the range of subjects you’ll have to choose from. So for example, there are lots of experiments I would not participate in for $100, but if instead you offered $1000 I might well put my name in. Of course, someone who desperately needs money will enroll in either case, but they’ll be better if (assuming they’re selected) with the larger compensation.
Now someone has to set the compensation for these experiments and that’s usually some Institutional Review Board (IRB). The IRB wants to offer enough money to get a good number of volunteers, but it doesn’t want to offer too much money. You might think the concern with offering too much money is about budgetary constraints and cost to the experimenter, but I gather it is not. (At least, these are not the terms in which it is most commonly expressed.) Rather, the concern about paying too much is tied to concerns about coercion. Too much money means that subjects do not freely choose to participate in the experiment but are instead coerced into participation. (The general outlines here should be looking a little familiar as they are the same as in the debates about paying egg providers, a topic I’ve written quite a bit about.)
Now I really want to put “coerced” in quotes above, because this is not exactly what I think of as coercion 0r to the extent it is, the use of the word seems to make careful reasoning harder rather than easier.
Consider first the point of view of the person who needs money desperately. They would take the $100. Are the better or worse off if we instead offer $1000? Are they more “coerced” than they were? It’s not clear to me that they are. And what this highlights for me is that the problem isn’t the money offered, really-it’s the initial poverty that creates the need.
What about the person who wouldn’t participate at $100 but would at $1000? Offering the larger amount of money changes their reaction–if they’re doing some cost/benefit analysis, the benefits of participation now outweigh the costs. This doesn’t mean the underestimate the costs necessarily. I suppose they have a greater motive to underestimate the costs and I know we are not exactly rational actors all the time. But still, if there is a problem here I’m not sure it is one of coercion.
I do understand that IRBs and other fee-setting entities have to operate in a real world where there is desperate poverty and so perhaps that earlier point is irrelevant. I do see the danger of paying people to do something that is flat out too dangerous for anyone to do. But where it is something we agree that some people should do, then I have a harder time seeing the problem with over-paying.
None of this is really specific to the egg provider problem, but it all does lurk in the background.