blog.bioethics.net

Ethical Mountain or Ethical Molehill?
John Robertson on the Matter of Korea

Guest blogger John Robertson offers this:

The attention slathered on Dr. Hwang Woo Suk’s belated admission that two lab workers donated eggs to his nuclear transfer work suggests the greatest ethical lapses since Ricardo Asch stole embryos at UC-Irvine. But some bioethicists are making a mountain out of a molehill. The road to nuclear transfer research needs speed bumps but not barriers. The science is tough enough.

Yes, we need clear rules for how eggs and somatic cells are derived, and yes, we have to reassure the international public that everything is on the up and up in the bright new world of embryonic stem cell research. Granted, too, that lab workers should not be egg donors, and erring researchers should ‘fess up immediately to wrong.

But crucifying Hwang and canonizing Gerald Schatten for his prescient resignation is a bit much. From my e-view of these happenings, Hwang may have lacked culpability about the underlying question of lab worker involvement. He might have run imposed tighter controls on egg sources but appears not to have directly induced or even been aware of two contributions from lab workers. He certainly did err in not coming clean up-front. Now that he has done his public mea culpa I say the time is to forgive him and let him get back to plying his considerable craft.

The same for the shrieks of horror at the news that some of the eggs came from paid donors. It appears that Hwang’s source of eggs actually paid twenty women for their time and effort but was not straight with Hwang about it. But with rules unclear and no legal barrier neither he nor Hwang should be pariahs for paying women for the time and effort expended in providing eggs.

The idea that it is wrong to pay egg donors for their contribution is much less tenable than the bar on using lab workers. A system of paid donation for infertility has developed in the United States that works reasonably well, e.g., few accounts of injured or misled donors or exploitation of the underclasses. With some tweaking (nothing is perfect) it could easily be extended to paying egg donors ESC research when the need for eggs to create new ESC lines or tailor them to particular genomes arises.

Indeed, the National Academy of Sciences never made a principled argument for their judgment that egg donors should receive no money for undergoing hormonal stimulation, close monitoring, and surgical retrieval. In opting for prudence over expediency, they clearly made a political choice to get the field moving, not an ethical one grounded in sound analysis.

We do not treat women as objects with no interests or rights when we compensate them for the time, effort, and discomfort of being egg donors. Nor do we coerce them to be donors when we pay them. Yes, financial need will be part of the motivation, but so will be a willingness to help others, just as it motivates egg donors for infertile couples. As Ezekiel Emmanuel has reminded us about “unfair inducements” in research rules, there is no “there” there. Let’s pay attention to the consent process, make sure that the egg retrievers are qualified, and that medical treatment will be provided for any injuries, but there should be no barrier to payment as such. Let’s also agree never willingly to use the term ”commodification”until someone shows that it clarifies rather than confuses discussion of an issue.

The ethical purity sought in barring payments would also cast doubt on most likely source of unpaid volunteers—patient families and relatives. Surely helping a loved one or their disease group will be as strong an incentive in many cases as the fees that egg donors for infertility typically receive ($3000-$5000 in many locales). But good reasons for doing unpleasant things always exert some pressure in life, and we make our choices accordingly.

Here David Magnus and Mildred Cho, despite their handwringing, may have a point. Yes, donating eggs for research is a new role of sorts so let’s focus on treating donors with respect while allowing important research to go on. Extra monitoring of the consent process might also work. But the rush to regulation has its costs. Researchers who need eggs for new ESC lines or disease models should not have to deal with egg shortages that financial payments would alleviate.

John holds the Vinson & Elkins Chair at The University of Texas School of Law at Austin.