Payment for Egg Donation and Surrogacy

University at Albany, State University of New York Scholars Archive Philosophy Faculty Scholarship Philosophy 9-2004 Payment for Egg Donation and Surrogacy Bonnie Steinbock University at Albany, State University of New York, [email protected] Follow this and additional works at: https://scholarsarchive.library.albany.edu/cas_philosophy_scholar Part of the Ethics and Political Philosophy Commons Recommended Citation THE MOUNT SINAI JOURNAL OF MEDICINE Vol. 71 No. 4 This Article is brought to you for free and open access by the Philosophy at Scholars Archive. It has been accepted for inclusion in Philosophy Faculty Scholarship by an authorized administrator of Scholars Archive. For more information, please contact [email protected]. Payment for Egg Donation and Surrogacy BONNIE STEINBOCK, PH.D. Abstract This article examines the ethics of egg donation. It begins by looking at objections to noncommercial gamete donation, and then takes up criticism of commercial egg donation. After discussing arguments based on concern for offspring, inequality, commodification, exploitation of donors, and threats to the family, I conclude that some payment to donors is ethically accept- able. Donors should not be paid for their eggs, but rather they should be compensated for the burdens of egg retrieval. Making the distinction between compensation for burdens and payment for a product has the advantages of limiting payment, not distinguishing between donors on the basis of their traits, and ensuring that donors are paid regardless of the number or quality of eggs retrieved. Key Words: Egg donation, ethics, commodification, payment, coercion, exploitation, informed con- sent, altruism, families. BOTH PAYMENT FOR EGG DONATION and payment possibility that there will be a child, or children, for surrogacy raise ethical issues. I will address genetically linked to her out there in the world, only egg donation, for two reasons. First, more she does not have to contemplate surrendering a has been written about surrogacy than about egg child to whom she has given birth. Additionally, donation. Second, and more important, the two a child born from a surrogate arrangement may practices raise very different ethical issues. Sur- feel abandoned by the biological mother, just as rogacy, or contract pregnancy as some prefer to an adopted child often does. The feelings of re- call it, involves giving birth to a child and then jection by such children are likely to be com- waiving one's rights to custody of that child. In pounded by the recognition that the birth moth- a few well-publicized cases, surrogates have ers conceived them and relinquished them for changed their minds and attempted to keep the money. It is implausible that a child conceived children. This has never, to my knowledge, oc- through egg donation would feel the same way. curred with egg donation. This is because there Finally, whatever may be wrong with commer- is a huge psychological and emotional differ- cial egg donation, it cannot plausibly be charac- ence between giving someone else your egg to terized as "baby selling." gestate and deliver a baby, and gestating and de- livering a baby yourself and then giving that A Terminological Point: "Donors" vs. baby to someone else. Indeed, in most cases, the "Vendors" egg donor does not even know if a child resulted from her donation. While a donor certainly Some view the term "commercial egg dona- should think about how she will feel about the tion" as an oxymoron. Thomas Murray (1) writes, "Despite the repeated reference to 'donors' of both ovum and sperm, paying indi- Address all coirespondence to Bonnie Steinbock, Ph.D., Professor viduals for their biological products makes and Chair, Philosophy, Humanities 257, SUNY Albany, 1400 them vendors, not donors." He recommends Washington Avenue, Albany, NY 12222-0001; email: stein- that the term "AID" (artificial insemination by [email protected] donor) should really be "AIV" (artificial insem- Presented at the Issues in Medical Ethics 2001 Conference on "Medicine, Money, and Morals" at the Mount Sinai School of ination by vendor). In response, some maintain Medicine, New York, NY on November 2, 2001, and updated as that paying gamete providers does not make of February 2004. them vendors, because they are not being paid © THE MOUNT SINAI JOURNAL OF MEDICINE Vol. 71 No. 4 September 2004 255 256 THE MOUNT SINAI JOURNAL OF MEDICINE September 2004 for a product, but are being compensated for ble, it does not follow that it is desirable, their time, inconvenience, and risk. I will have praiseworthy, or decent. more to say about this later. In the meantime, I The practice of commercial egg donation continue to use the term "donation" even when has come under severe criticism, but before ex- referring to the commercial enterprise, not be- amining the ethics of paying donors, we need to cause I want to prejudge the question of see if there is something intrinsically wrong whether payment is for the product or compen- about donating one's gametes to others for the sation, still less to prejudge the question of purposes of reproduction, even in the absence moral acceptability, but simply because it is ac- of any payment. cepted usage. Noncommercial Gamete Donation Law and Morality The Roman Catholic Church opposes ga- One important distinction is between the le- mete (ovum or sperm) donation because of its gality and the morality of egg donation. While views on the unity of sexual intercourse and legality and morality are not entirely separate, procreation. Sexual intercourse without open- and arguments for making something illegal are ness to procreation is wrong, the Church claims often moral arguments, the two often raise dif- (hence its opposition to birth control), but ferent issues. In Germany, Norway, Sweden, equally so is procreation without sexual inter- and Japan, the use of donor eggs is illegal (2). course (hence its opposition to most forms of It is unlikely that egg donation could be banned assisted reproduction). Even the "simple case" in the United States, because such a ban would of in vitro fertilization (IVF), where the hus- probably violate the constitutional right to pri- band and wife provide the gametes and the re- vacy (3). What about banning payments to egg sulting embryos are implanted in the wife's donors? In Canada, there is proposed legislation uterus, is impermissible, according to Catholic to ban the "buying and selling of eggs, sperm teaching. The wrong is compounded in gamete and embryos, including their exchange for donation, as the introduction of "a third party" goods, services or other benefits...." The Minis- violates the unity of marriage. In addition, ac- ter of Health adds (4), "This prohibition will cording to the Rev. Albert Moraczewski, egg come into force over a period of time to ease the donation is demeaning to women, "A donor transition from the current commercial system woman is not really being treated as a person," to an altruistic system." Legislation in the he said. "Whether she is paid or acts out of United States banning payment to egg donors kindness, her egg is being used, so she is not might not withstand constitutional scrutiny. It fully treated as a person whose reproductive ca- would depend on whether or not banning pay- pacity should be expressed as a result of the ment is viewed as an undue restriction on pro- love of her husband" (6). creative liberty. The point I am making is that But why is egg donation demeaning? Pre- even if there are serious moral objections to sumably blood donation is not demeaning, and commercial egg donation, there could be con- does not fail to treat the donor as a person. What stitutional barriers to making it illegal. is the difference? The answer, according to the When the topic is the morality of a contro- Vatican, is that egg donation involves a wrong- versial practice, an important question is ful use of reproductive capacity. But then to whether it is morally permissible. However, this characterize egg donation as demeaning is not to is not the only question we can ask. Margaret give a reason why it is wrong; rather, egg dona- Little characterizes moral permissibility as "the tion is demeaning because it is wrong. To see thinnest moral assessment." Writing about egg donation as demeaning, one must accept the abortion. Little (5) says, "... many of our deep- principle that reproductive capacity should be est struggles with the morality of abortion con- exercised only through a sexual act in the concern much more textured questions about its text of a loving marriage. And that principle is placement on the scales of decency, respectful- justified by the supposedly indissolvable unity ness, and responsibility. It is one thing to decide of sex, love and procreation. There is nothing that an abortion was permissible, quite another inconsistent or incoherent in this view, but it is to decide that it was honorable; one thing to de- unlikely to be persuasive to non-Catholics who cide that an abortion was impermissible, quite accept contraception or assisted reproduction. another to decide that it was monstrous." So A different objection to gamete, specifically even if paying egg donors is morally permissi- sperm, donation comes from Daniel Callahan. Vol. 71 No. 4 PAYMENT FOR EGG DONATION AND SURROGACY-STEINBOCK 257 AID is "fundamentally wrong," according to child-rearing responsibilities without much Callahan, because a sperm donor is a father, thought is reprehensible; one thinks of Rousseau, who has all the duties of any other biological who took five illegitimate children he had with father, including rearing responsibilities. Sperm his mistress to an orphanage. But is that what donation, according to Callahan, is as irrespon- gamete donors do? Sperm and ova are not, after sible as abandoning a woman when she be- all, children.

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