FAQs on Payment for Egg Donation
1. What are the current rules on egg donation?
Egg donation has been taking place in Britain for around 20 years. In the current system women who want to donate eggs (often a friend or family member) do so altruistically, simply because they want to help another woman. Donors and children who have been conceived through egg donation have always strongly insisted that it is vital that donation is altruistic and that financial incentives do not enter into this process.
The EU Tissues and Cells Directive (2004/23/EC) prohibits anyone from buying and selling human tissue for profit. However, the Directive allows donors to be reimbursed for the direct expenses and inconvenience of donation, with national authorities in the member states setting the level of compensation. Thus, the Directive bans direct payments for eggs, but if the amount of compensation for inconvenience of donation is set at a high level, this can function as a financial incentive. In Spain, the authorities have allowed clinics to pay women 1,000 Euros in compensation, and this has served to greatly increase the supply of donor eggs, making Spain the preferred destination for British women who cannot receive egg donation in the UK because of the shortage of eggs. The HFEA is now proposing to copy the Spanish authorities, although it has been suggested that British women might be paid £1,500, equivalent to over 2,000 Euros.
In 2006 the HFEA conducted a full policy review on these issues, and decided that egg donors could receive expenses up to a maximum of £250, but could not be paid for their eggs. It is this policy which, only three years later, the HFEA chair, Lisa Jardine is planning to change.
The other exception to the rule against payment is the system known as ‘egg sharing’. In 2002 the HFEA decided that women who were undergoing IVF could receive reductions in the cost of their IVF if they donated a proportion of their eggs to other women. The HFEA argued that this was different from simply paying women to donate eggs. However, many IVF clinics are now offering women free IVF, worth £3,000 – £5,000 in exchange for some of their eggs, which certainly seems against the spirit of the alturistic system. Since such women are already undergoing IVF, they are not being induced to take risks which they would otherwise not have taken, but since most of these women will be less well off, may be reducing their chances of getting pregnant because of their financial situation.
2. What is the law in Britain concerning the sale of organs?
The main legislation in this area is the Human Tissue Act 2006, which was brought in after the scandals concerning pathologists’ appropriation of organs from dead babies without parents consent at the Alder Hey Hospital in Liverpool. That act bans payment for organs or tissues used in transplantation. However, the Act specifically excludes reproductive tissues and cells, which are dealt with separately by the Human Fertilisation and Embryology Act 2008. As noted above the EU Tissues and Cells Directive also bans payments for organs, but allows donors to be compensated for the exspenses and inconvieniences of donation.
3. What is the basis for the claim that the human body has a special ethical status which means that it should not be turned into a commodity?
Clearly, some things have an intrinsic value, which is separate from their cash value. Examples might include ecosystems and human beings. It is partly because parts of the human body have been part of a particular person that they have their own intrinsic value. That is why, for example, the parents of those children whose organs were removed without consent at the Alder Hey Hospital in Liverpool were very anxious to have those body parts returned to them so that they might be buried. You can call the parents’ feelings irrational, but they show the importance of other types of value than the cash price. The special status of human material, which depends on the special status of human beings, has been part of almost every culture, and is what underlies legal bans on trading in human material in many countries. It is widely felt that that special status is very important and must not be degraded by reducing human material to the same status as ordinary goods.
It seems particularly important to keep a clear separation from the free market in the sphere of reproduction, where the human cells are actually being used to create a new life.
4. We live in a society in which everything is sold as a commodity. If egg donation is ethically acceptable when done without payment, why does payment make it wrong?
What is wrong with allowing payment for egg donation is that it changes the whole nature of the situation, and inexorably moves it into the sphere of trade and the free market.
It’s true enough that in our free market society everything gets turned into a commodity. However, two wrongs do not make a right. In general, capitalism expands by a relentless process of commodification of what was previously non-commodified, the accompanying privatisation of common resources, and the subjection of every aspect of human life to the market. It generally makes sense to oppose that, and the proposal to allow the selling of eggs is just the latest example, which also happens to have a palpably bad effect on poor women’s health. In the area of human tissue, the traditional, non-free-market system for blood and organ donation, based on altruism, the gift relationship, and non-commodification is still strong and viable and should be defended.
Over the past 30 years, as biotechnology developments have made human tissues medically valuable, scientists and corporations have become increasingly keen to acquire them, and this has led to new forms of exploitation and oppression. Aside from the exploitation of Third World people in the organ trade, examples include the wholesale patenting of human genes and the patenting of human cells taken from indigenous peoples without consent. The feminist bioethicist, Donna Dickenson, in her book, “Body Shopping” argues that women’s bodies have been especially targeted by these industries. She details one of the worst cases, in which Korean scientist, Hwang Woo Suk, obtained literally thousands of eggs for his cloning research by coercing junior lab assistants and paying other women, using high hormone doses that led to many cases of Ovarian Hyperstimulation Syndrome.
In the case of eggs, one example of the consequences of letting market principles apply is that you start to get higher prices for “superior quality” products. Thus, in the USA, women at Ivy League Universities can get tens of thousands of dollars for their eggs, whereas poor women only get a few hundred dollars, and free market eugenics begins to operate. With blood, the problem in the USA has been that offering payment for donations, as with eggs, incentivises the poorest and most desperate, including drug users, who do not report, or are not aware of the infectious diseases they carry, which can then pass into the general blood supply.
It should be noted that even if a standard price for eggs were set by a government regulatory body, the financial incentive for poorer women to take the risks still remains.
5. Surely it’s my choice about how I use my body and the risks I take?
Actually, that’s beside the point here – this is not a campaign against egg donation per se, and we are not telling people not to be an egg donor. This campaign is about not letting market principles run the show. That is a question of social policy, which has to start from what’s best for society at large, including the protection of women’s health. A simple assertion of individual liberty is not an adequate response to that question: that is why we have health and safety at work legislation, for example.
The question about the extent of an individual’s rights concerning their body is difficult and politically contested. However, many people feel that it cannot be an absolute right. This can easily be seen by imagining yourself standing on a train platform next to someone who is obviously about to jump in front of a train. Do you try to stop them, or do you say, ‘It’s their right to commit suicide‘? Most people would feel that it was their positive duty to try to stop their neighbour from committing suicide, so for them it cannot be the case that people have an absolute right to do anything they want with their body.
6. Currently, although egg donors are not paid, the private IVF clinics are making a fortune. Surely it would be fairer to pay the egg donors since they are providing the crucial material? Isn’t denying payment to women just a typical example of the sexist demand that women be altruistic?
It’s true that this situation seems unfair. If we believe that private medicine is legitimate, then, of course, IVF clinics have to be paid for their staff costs and overheads. However, if we agree that body parts are not commodities, then it is right that women should not be paid. Most blood donors do not feel themselves exploited when they give blood freely, and neither do kidney donors: in fact, even though donating a kidney is more invasive even an egg donation, kidney donors would probably be offended at the suggestion that they should be paid for what they regard as a gift of love.
The issue of sexism can be looked at in another way. Over the past 30 years we have seen the creation of a series of reproductive technologies, which have been successful in giving some infertile women babies. This has built up expectations that we should be able to solve all infertility problems. However, because the process of egg donation is so arduous and risky, there are now more women wanting eggs then there are donors in Britain, so there is a waiting list. We are in a situation where the technological tail is wagging the dog, and people feel that rather than accepting that there are not enough donors, it is of such paramount importance to give women babies that we should change established ethical rules. This is fundamentally bad ethics: we should not be encouraging women to take risks and undergo stressful procedures that they would not otherwise want to do. But we should question where the huge pressure to provide donors comes from. We would argue that it is partly caused by the high pressure on women in our society to be mothers. Arguing that women should be paid for eggs ignores this whole social process, as well as colluding in the general process of commodifying the human body discussed above. Feminists should be supporting infertile women rather than encouraging them to take risks with their health.
Although it is true that non-payment for egg donation looks a lot like the way women are traditionally supposed to be self-sacrificing, in fact in this case it applies equally to men, who are also, rightly, not paid for sperm donation.
7. What about egg sharing, which is already allowed?
Egg sharing is a system in which women undergoing IVF give some of their eggs to other women in exchange for a discount on the fees for their treatment. It’s true that this is a form of payment for eggs, and as such ethically very questionable. However, unlike the straightforward payment for the egg donation scheme that the HFEA is advocating, the women who are involved in egg sharing have already decided to undertake the risks of IVF for their own purposes, and are not being induced to take those risks by the financial incentive.
8. What is your position on IVF and on egg donation?
The No2Eggsploitation group does not have any policy on these subjects, and there are differing views within the group. We recognise that there can be feminist arguments made both for and against IVF and egg donation. Our agreement that payment for egg donation is wrong does not depend on any particular position on IVF or egg donation. But we hope that this campaign will begin a broader feminist debate on reproductive technologies, which has been lacking in Britain in recent years.
8. How will payment for egg donation work?
In some countries, private IVF clinics advertise for egg donors and pay them to donate eggs. The clinics then charge their patients for the eggs (presumably with a mark up that goes to the clinic). In some cases clinics even trade eggs between themselves. It is not clear what the HFEA plans to do in Britain.
9. Since the Human Tissue Act bans the sale of tissues and organs, doesn’t that mean that an HFEA decision to allow sales of eggs will not lead to a market in organs? Anyway, such ‘slippery slope’ arguments are not valid: the law should be made on the basis of what is morally acceptable now and not on what may happen in the future.
The current legal situation means that, yes, it is true that there would need to be a change in the law to allow sales of organs. However, there are often calls by transplant surgeons to allow the sale of organs, in order to make up the shortfall in Britain, and allowing the sale of eggs would make an eventual change in the law much more likely, since it would establish the principle that human tissue can be sold. People would start to argue that life-saving organs are much more important than treating infertility, and that if market incentives are allowed for eggs, then why not for organs too? People are already arguing, as the HFEA has done with respect to their eggs, that the only way to overcome the black market in organs is to legalise and regulate it.
The term ‘slippery slope’ is completely inadequate to describe this social process: slippage implies something happening passively, or by accident, but in fact there are thousands of people employed to make sure that these changes, always in the direction of liberalisation, happen. There are scientists who are constantly developing new technologies, and their lobby groups insisting on their academic freedom to pursue whatever research they like; there are the ideological supporters of liberty, free markets and consumerism, who insist that the constant erosion of accepted rules in medical ethics must necessarily be progress; and there are the pharmaceutical, biotechnology and IVF industries looking to open up new markets and dispose of ethical barriers to their profits, and with their huge influence on politicians. Given the fact that the organ trade already exists, and that calls to legalise it are already being made, it doesn’t seem too far-fetched a prediction that legalising the sale of eggs will lead to a market in organs, too. In the face of all this, it is crucial to defend ethical principles, such as non-commodification, and to ensure that we do not open the door to further abuses.