red robot

They're discussing on the radio right now (88.5 if you're in the SF Bay Area) an aspect of cloning ethincs I'd not hear mentioned before.

Cloning/stem cell research exploits women by requiring the harvesting/donation of oocytes. I'm just listening to the show now, and I thought I'd bring this up here to see what you all think.

Please iginore if this has been discussed before.

rr

pz

Well, yeah. The women get several weeks of hormone injections to induce hyperovulation, which is bad enough...but then they also get this lovely surgical intrusion in which their ovaries are poked and snipped at to collect the eggs. From some of the women I've talked to about this, it's horrible. The hormones scramble your metabolism and leave you feeling miserable, and the pain of the procedure is intense, like amped-up menstrual cramps.

At a local IVF clinic, they will pay young, healthy women roughly $5000-6000 to go through this, which is fairly good money, but I suspect it is not worth it.

The same clinic pays men $50 to make a deposit of their gametes, and they can do this twice a week. That adds up to a fairly good bonus every month, all for doing something most guys do routinely anyway (there is a catch: extensive preliminary blood work for various diseases is required first, and you only get paid 6 months later when followup tests confirm that you've been disease free).

red robot

I think it's important to mention, though, that this is a completely voluntary process (I believe things would be different if women were pushed to this out of a need for money). Organ donation, marrow donation, even blood and plasma donation expoit the donors, but they go through surgery, etc. voluntarily. Is this different?

pz

Here's an odd thing. I've read the literature and talked to the doctors who do this procedure, and they all describe this as a simple, low-risk procedure (which is true).

Then I spent some time talking to a woman who went through it...and it was a completely different story. This was a person who was so desperate to have a child that she'd spent many tens of thousands of dollars and years going through fertility clinics, and yet when she was actually on the operating table and the doctors were doing the harvesting, the pain was so intense that she had to call an end to it after they'd collected 8 eggs (they usually want more). When I talked to her, she was kicking herself with guilt over it, but at the same time she had to admit that the misery of that month and the agony of that hour in the clinic were so great, that she'd never do it again.

She ended up adopting.

Anyway, I think there is a real problem with informed consent here. The money is also a problem in any tissue donation procedure.

brighid

Well, I can’t see any issue of exploitation with the voluntary harvesting of eggs, and I say this as a woman who has undergone the procedure as an anonymous donor to an infertile couple. The screening procedure is pretty thorough and women who are drug users, alcoholics, who have had risky sex lives or test positive to certain diseases won’t be selected as candidates. It is then up to a couple to pick a donor. A woman may never get chosen.

I was fully informed as to the possible consequences of the procedure. I was given a complete physical, more thorough then ones I would normally get. All the necessary medical treatment was provided to me for free, at the expense of the couple and I was fairly compensated. It took roughly two months to prepare my eggs for harvesting. I had to sync up my ovulation cycle with the woman to whom I was donating the eggs. This required two back-to-back cycles of birth control pills. After this I took daily hormone injections I administered myself for approximately a week, then the injections increased to two a day, and then toward the end it was about 4 a day. It required that I abstain from sexual intercourse. It required a travel to the clinic (which was not close to my home), undergo frequent internal examinations and toward the end that required daily and internal, ultrasound examination, have my blood tested, etc., and it took quite a lot of effort. I was adequately compensated, considering the difficulty in harvesting my eggs. It is not an “easy” procedure, but neither was it terribly difficult. It required general anesthesia in which I was conscious and the harvesting procedure took about 15 minutes. It was not painful for me at all. I had to have someone drive me home and I took a day off of work and used the weekend to recoup. The worst part was not the actual harvesting, but the time after coming off the hormone injections and the time it took my body to get back to normal. The total process from beginning to end was about six months.

Unlike blood donation, or even bone marrow donation … the procedures necessary to donate eggs require much more time and come with other inherent risks. The procedure can be painful for some women, whereas ejaculating into a cup can hardly be seen as painful. Unfortunately you simply cannot tell how it will be for any woman and the doctors and his staff did not sugar coat the procedure for me. I was expecting it to be much more painful then it actually was. I was surprised and thankful.

The donation will hopefully allow a couple to have a child they would otherwise be unable to have and the range for payment is between $3-6,000 depending on the agency and complexity of the procedure.

I would not likely do it again because it was so difficult to do. It took a lot of time and effort and I internal ultrasounds are not the most pleasant experience. I was glad I did it and I truly hope the couple that chose me was able to conceive a healthy child from this. I will likely never know.

Women aren’t lining up in droves to do this procedure. There is no exploitation and if a woman chooses to undergo this lengthy and potentially painful procedure I see no reason to call this exploitation. Women aren’t be coerced, or even encouraged to do this. They are amply compensated for their time and effort, and rightfully so.

If women choose to donate their eggs to science so that someday millions of people can be cured of debilitation diseases such as Alzheimer’s, diabetes, cancer, spinal cord injuries, cloning of tissue for burn victims, the creation of organs without the necessity of having a living or dead donor, etc. Then SO BE IT! It is for a far greater good and unlike forced prostitution, no one is harmed and the woman directly benefits, chooses said action freely, directly benefits and hopefully helps humanity and helps an infertile couple, desperately wanting a child have a healthy child.

Why should these women NOT be compensated?

Brighid

pz

The ethical dilemma of compensation is not that the women don't deserve it, but that it is an external inducement that might encourage desperate people to undergo a procedure that they would never consider otherwise.

brighid

Desperate in what way and how would that desperation play with regard to the immorality of the issue?

Brighid

pz

Say you're a poor college student, with growing debt and looming tuition payments. You are exactly the kind of person targeted by this strategy of offering $5K for some eggs. You wouldn't necessarily be making this decision out of an altruistic desire to help someone, but purely because you need the money. This isn't a good thing. It turns people into meat machines, and discriminates against the poor.

Note that the immorality here is not on the part of the woman, but on the individuals or organizations that are commodifying her organs.

There's a brief discussion of the issue on CNN. You can find another discussion in this Bioethics FAQ.

brighid

I can understand that perspective, but most college students are poor. They are also at the proper age for the best egg harvesting because of their youth and health of their eggs, so naturally they would be the “target” audience. Unfortunately, most of us during our prime fertilization years don’t seem to enjoy the financial security that sometimes comes with age and experience.

If you are poor, and you have an option to undertake a task that has a low chance of causing you actual harm, but will help another person (even if that is not the driving motive) and it will help you financially … where is the harm? Do I, as a donor, need to be altruistically motivated for this action to be moral, or if the reason I choose to undergo said procedure is to remove myself from a financial bind has my action been made immoral due to motive?

Every woman that seeks to undergo egg harvesting will not be chosen for any number of reasons.

I will give my motivation for having undergone this procedure, and you are correct if I had not needed the money I might not have undergone it. I probably would not have even known about it, but in my case I did. I needed the money to retain an attorney in order to protect my son from his biological father. His father had become physically abusive (as well as criminally violent with me) and other less expensive outlets had been exhausted. I need the money to retain a good attorney who would protect my child and fight for him. I was a single parent. There was no one to loan me that money, I would be unable to pay it back and I certainly did not have the credit to get a loan, and I tried. So, I suppose you could classify me as desperate. The only way that I could personally come up with the thousands of dollars it would require to retain a good attorney were either through illegal and degrading means, or by donating my eggs. It was an easy choice. I was not initially motivated by the altruistic nature of helping a stranger conceive a child, but it WAS THEE overriding motivation when ultimately making my decision. Not only would I be helping an infertile couple have a child, but in turn I would be protecting my own. It was legal, I would be the only one assuming any potential harm (and it was worth the risk considering the harm that was and would be coming to my child), I would incur no further debt and something good would hopefully come out of it for myself and for the couple whom I donated too.

Every month each woman passes one or more eggs. We are born with tens of thousands of eggs, and only a few will actually develop into a human being. Our unfertilized eggs hold the keys to curing disease and in many cases, simply fulfilling the dreams of parenthood for infertile couples. A woman is amply compensated for her time and efforts and unfortunately, desperation will come into play. However, unless a woman is used over and over and over again, to the detriment of her health and does so without full knowledge of what is happening … I cannot see how, even in desperation situations this is exploitation.

Egg harvesting is not a fun procedure. Most women aren’t going to just undergo it without some self-motivating factor. Honestly, who wants to undergo two-three consecutive cycles of birth control pills, daily and self-administered hormone injections that increase in frequency, as well as more painful ones that are later administered in the hip, extensive medical screening, frequent internal examinations, and then extracting numerous eggs via a needle almost as long as ones arm, under semi-conscious conditions that can’t be guaranteed to be pain free? Even for a couple thousand dollars?

So, one “desperate” situation motivates another human being to help another person in an equally, yet different “desperate” situation. Both are helped and little or no harm is done.

How does desperation, or the lack of desperation in motive equate to a situation being either moral or immoral? Why isn’t it good for a woman in a desperate situation to avail herself of reducing or eliminating that situation through donating eggs, blood, marrow, or other non-vital materials that in turn help another?

Should women undergo this type of procedure for free?

Brighid

pz

You aren't paying attention to what I am saying.

It is NOT immoral for a woman to avail herself of this kind of opportunity to overcome a difficult situation. No censure is intended of people who do this. If anything, they are victims.

The ethical compromise is on the other side of the exchange. The doctors are trading money for blood and pain. This is most un-Hippocratic of them, don't you think? It is, however, a compromise because they are at least compensating people monetarily for the small amount of harm they are doing. It is still very much an ethical gray area.

In a just society, a woman wouldn't have to submit to a surgical procedure in order to protect her child from an abusive father. You did it as a better alternative than allowing a bad parent to harm your kid, but that's a situation that, in a perfect world, shouldn't happen anyway.