- BIOETHICS FORUM ESSAY
Paying Egg Donors for Research: In Defense of New York’s Landmark Decision
On June 11, the Empire State Stem Cell Board voted to allow funding of research on stem cell lines derived using eggs donated solely for research purposes, where the donor was compensated for her expense, time, burden, and discomfort, within specified limits, as is currently permitted when women donate oocytes for reproductive purposes in New York State. Although the wording of the resolution focused on the funding of research, in effect it allows women who donate oocytes for research purposes to be paid. New York is believed to be the first state to allow payment to women who provide eggs for research.
Why have other states, which allow compensation to women who donate their eggs for reproductive purposes, declined to permit such compensation if the oocytes will be used in research? Clearly, there is a political rationale.
Given that embryonic stem cell research is very controversial, supporters have attempted to avoid charges of “commercialization” and “commodification” by taking payment to egg donors off the table. Politics aside, are there good reasons against compensating egg providers if the eggs will be used for research?
One objection comes from Alan O. Trounson, president of the California Institute for Regenerative Medicine, who told The Chronicle of Higher Education that stem cell researchers need large numbers of eggs only if they plan to create embryonic stem cells through somatic cell nuclear transfer, or cloning. Some scientists are exploring less controversial ways of deriving stem cells, such as induced pluripotent stem cells, or iPS cells.
According to Trounson, reviewers for the Institute “have not supported any recent applications for nuclear transfer in the human but are supporting many iPS cell studies.” He added that leading scientists think that iPS cells offer something more than nuclear transfer at present.
However, even if cloning human embryos does not prove fruitful as a source of stem cells, human oocytes might have other uses in research. As George Daley, a stem cell researcher at Harvard and Children’s Hospital Boston, points out in The New York Times, “There are many questions you can only answer by studying human eggs.”
Moreover, the objection does not address the ethics of payment at all. If oocytes are not needed for research, then women will not be encouraged to donate. The payment question is whether they should be compensated if they do donate. Is there a reason to treat differently donors whose eggs will be used for reproduction and donors whose eggs will be used for research?
One concern is exploitation of women who might be induced to donate by the prospect of earning as much as $10,000 per cycle. “It will be the vulnerable classes of cash-strapped and college-aged women who will be exploited by the state in this scheme,” said Rev. Thomas V. Berg, a member of the state stem-cell board’s Ethics Committee who is also a Roman Catholic priest.
Undue inducement is a real concern in egg donation generally. For many women, the chance to earn $5,000 to $10,000 would be very attractive, and might lead them to discount the burdens (two weeks of daily injections and what has been characterized as comparable to “the worst period you’ve ever had”) and risks.
However, the burdens and risks are precisely the same, regardless of how the eggs are used. The potential for exploitation does not justify treating donors differently. Moreover, women who are given full information about the risks and burdens are surely capable of making the decision to donate for themselves.
If the exploitation objection errs on the side of overprotecting women, and thus veers on paternalism, a different concern is that women should be motivated by altruism, not money. But why should egg providers be motivated solely by altruism?
Everyone involved in infertility treatment gets paid: the doctors, the nurses, the receptionists – why should those who provide the eggs be the only ones who are expected to give of their time, and undergo risks and burdens, for free? Justice requires reasonable compensation for the time, expense, burden and discomfort occasioned by the procedure.
It is accepted practice for women to provide eggs to other women who want to have babies. Surely the same consideration applies in the case of eggs for research, since the time, expense, burdens, and risks are identical. Although women who provide eggs to other women who want to have babies typically do have altruistic motives, virtually no women are willing to undergo the rigors of egg donation to strangers without some compensation.
It seems absurd to require that women who want to support embryo research (without with, it should be noted, infertility treatment would not exist, and cannot further progress) should be required to be more altruistic than those who give their eggs for reproductive purposes. Moreover, as the ethics board pointed out, the social value of the research is potentially greater than that of enabling individuals to reproduce.
The argument made by the board was not simply that the research requires eggs and women are being paid for their eggs anyway. It was that the research is morally permissible and potentially extremely valuable, and that similar cases should be treated alike, a fundamental principle of reason and justice.