Saturday, July 7, 2012

Ethics in Istanbul: Egg Donation Revisited

I attended the meeting of the European Society for Human Reproduction and Embryology last week in Istanbul. Some of the topics under discussion there are well-worn issues in fertility medicine, but sometimes having a new twist.  For example, speakers looked at the ethics of helping single women in Islamic societies have children, the ethics of helping homosexual men and women have children, and the ethics of helping transgender men and women have children. From an international perspective, not all these questions get answered in the same way, although the speakers I saw made a strong case for extending parenthood to all people as far as possible. 

The question of gamete donation continues to throw up concerns.  For example, should donors who act through medical institutions should be able to control who their sperm and eggs go to? Donors who make arrangements privately between themselves do exactly this. But would it be acceptable to allow donors to specific who could have access to their gametes and who could not, if they make those donations through fertility clinics? One speaker expressed strong skepticism of saying yes. 
In any case, how much donors should be ‘reimbursed’ or ‘compensated’? It turns out that different groups have different answers to this question.  The general public thinks that donors should be largely altruists, and not looking for any kind of financial benefit.  People closer to the process think that donors should be reimbursed for their time and effort, so that they are not made worse off by losing time and money by donating.  Some think that reimbursement should be robust, in order to attract a broad range of donors.  

I will mention one more topic along these lines:  egg donation.  Right now, egg preservation techniques are not as well developed as embryo preservation techniques.  But as clinicians improve their skill at egg freezing, more eggs will become available from women and couples who are looking for help in having children. When they succeed, some of their eggs will be left over, and they could be available for donation to others.  This outcome will make it less necessary to solicit egg donation from other women, thereby exposing fewer women to risks and making more eggs available for fertility medicine and for research.

It was a very interesting meeting, and it drove home to me the importance of thinking about fertility medicine as a global practice. Morally speaking, why should countries vary in what is available to their citizens by way of help in having children?  If a practice is morally defensible, why should it be banned anywhere? Or is it enough that countries decide, so long as ‘safety valves’ exist, namely the opportunity for people to travel to other countries to obtain what is forbidden in their own country? Is reproductive tourism a symptom of something wrong with national standards, or is it the necessary outcome of respect for national choice?