Paying egg donors: exploring the arguments.

The recent controversy over the procuring of eggs in Korea has brought attention to the oft-ignored women who provide eggs and embryos for cloning and embryonic stem cell research. Certainly the attention is a welcome change from arguments about armies of clones and other as-yet-unrealizable fears. But could the current controversy evidence a mistaken attitude towards the donation of bodily materials to research, as well as an overly paternalistic attitude towards young women? Four concerns have emerged about the use of egg donors in the now famous research led by Woo Suk Hwang of Seoul National University: (1) some of the egg donors were members of the research team--that is, they were Dr. Hwang's employees; (2) some donors were paid (apparently the equivalent of about $1,400); (3) researchers accompanied some donors as they went through the egg extraction procedure; and (4) the researchers then lied about (1) and (2). As early as March 2004, just a month after Hwang and his team first reported deriving an embryonic stem cell line from cloned human eggs, Nature published a news article questioning whether some egg donors were employees. Around the same time, Hwang told reporters that he had "held the hand" of at least one donor as she underwent surgical extraction of eggs for use in the research--a revelation he perhaps hoped would show a high level of concern for donors' well-being. Unfortunately, like his use of employee donors (although it appears Hwang may not have known that his employees donated, as they were apparently enrolled under false names), physically accompanying donors as they undergo egg extraction might be, or appear to be, incompatible with the requirement that participation in research be voluntary. Voluntariness is a core commitment of modern research ethics, and properly so. This commitment translates into requirements that no one be pressured to participate in research and that each participant be able to withdraw from the research at any time, without endangering ongoing medical care or the caregiving relationship with the researchers. Researchers usually avoid enrolling family members and employees for this reason, since they might reasonably feel compelled to participate. Fulfilling this commitment can also get tricky when physicians enroll their patients in their own research because the patients might feel that their ongoing care depends on pleasing their doctor. The commitment to voluntary participation, and specifically the derived right to withdraw from the research at any time, could also be under threat when researchers physically accompany participants to procedures--hence the concern over the hand-holding. Voluntariness is also the major factor motivating bans on compensating research participants, the argument being that the need for money could "compel" participation, especially, though not exclusively, among the poor. The objection to paid donation is sometimes inaccurately expressed as an objection that research participants should not benefit from the research; the mistake here is confusing the so-called "therapeutic misconception" with the draw of financial benefits. It is certainly not good for subjects to believe that the experiment is actually a treatment that will help them, but making clear to subjects that they may not benefit therapeutically from the study does not mean that all research subjects--or research donors--must be committed altruists. People participate in research for all sorts of reasons, many of them self-serving, including securing access to collateral care and furthering knowledge of a condition they suffer from and one day hope to receive better treatment for. In fact, many research subjects in the United States also receive compensation in exchange for enrollment in clinical trials or other investigations. Proponents of this practice argue that such payment, particularly where modest, is not only a necessary incentive but also fair treatment of research subjects. …