When automobile sales get sluggish, as they are these days for many U.S. automakers, Detroit often turns to rebates. A little cash back can help nudge a reluctant customer out of the recliner and into the showroom.
But is what works for cars right for human eggs?
Some British scientists propose offering rebates to women seeking infertility services in exchange for giving up some of their eggs to be used in stem cell research. So, if you are desperate to become pregnant and can't afford the pricey treatment, your extra eggs can serve as a half-price coupon.
If that is morally OK, and I have my doubts, would it then be ethically acceptable just to create a market for fertile women who want to sell eggs directly to researchers?
Proponents of human egg farming make a fairly straightforward case for why rebates or markets in eggs should be allowed. The core of their argument is that women, often college students, are already selling their eggs for cash to help infertile people who want to have babies.
Indeed, you can get a better idea of the relative standing of colleges than anything U.S. News and World Report has come up with by checking the going rate for eggs from coeds at prestigious universities. So the idea of paying for eggs is nothing new.
Sure, unlike obtaining sperm, where all you need is a man, a plastic cup and the right DVD, there are some risks associated with harvesting a woman's eggs. But as proponents of rebates and markets in eggs note, women (and men) do plenty of risky things for money. Women are soldiers, cops, construction workers, farm workers and pilots of small planes. Unlike the risks of these jobs, there are very few reported deaths and relatively few complications among women trying to make eggs either to get pregnant or to sell to third parties.
The clincher in the "why we should allow pay for eggs" argument is that getting them from volunteers does not work. A few infertility programs have asked women to donate eggs as part of their treatment and they have gotten next to none. If research is to move ahead then money in the form of rebates or direct payment is needed to fuel egg production.
Donors vs. sellers
Still, something clearly makes us uncomfortable with the idea because no one who argues for rebates or freewheeling egg markets ever refers to the women getting paid for their eggs as "sellers." They're always "donors." Of course women who get paid $5,000 or get half-off on the price of a cycle of in vitro fertilization, which is worth at least that much, are, in truth, sellers. No amount of rhetorical evasion can change that reality.
I think I know why it is hard to call an egg seller an egg seller. And it's not because we think it is wrong to pay people to take risks. Rather we think it is wrong to pay people to reproduce for money. It is the old moral issue of the commodification of sex that is lurking under the shell of the great egg rebate debate.
Many people have no problem with the law allowing people to pay other people for sex. Few, however, want to defend the practice as ethical. Even fewer want to recommend it as a way to earn money for their mothers, sisters or daughters.
That uneasy feeling
Giving rebates for eggs smacks of commercializing reproduction. On its face it is not quite as bad as instituting a market but it still feels ethically queasy. Who really wants their mother, sister or daughter to have to give away half their eggs and reduce their own chance of having a baby in order to gain access to infertility treatment? Worse still, who really wants their sister or daughter working their way through college as an egg seller?
It is one thing to argue that we should be using spare or unwanted embryos that already exist for research since they will be destroyed anyway. But making eggs for money is a different matter. The market in eggs tries to incentivize women to do something they otherwise would not do.
Egg sales and egg rebates are not the ethical way to go. We need better alternatives. Maybe women seeking in vitro fertilization could have some of their eggs frozen and then used for research if they do get pregnant. That way they are not forced to compromise their odds at making a baby just to get a chance at all. And maybe instead of buying eggs from students and the financially disadvantaged we could procure them from women who are willing to donate their ovaries when they die.
It's not that markets or rebates for eggs ought to be illegal, but we should not let proponents egg us on into thinking that it is ethical.
Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.