Babies for sale: market ethics and the new reproductive technologies.

INTRODUCTION Both historically and currently, there are several markets in which humans and human components are exchanged for money or other economically valued resources. In the past, persons were sold into slavery (Bullough and Bullough 1987) and women in the United States were considered chattel property of their husbands until the 20th century (Dworkin 1981). Laqueur (1983) writes that a thriving market in human cadavers and body parts for medical dissection existed in both France and England from the 1970s through the 1840s. Currently, four markets exist in which human components are exchanged for economic compensation concurrent with altruistic donations of the same components: human blood, human organs, surrogate motherhood, and human reproductive cells. Strong ethical and consumer policy issues have been raised by each of these markets. The ethical arguments already put forward for two--blood and human organs--will be reviewed and a possible model of exchange presented which can account for these concerns. This will be followed by a detailed application of the model in the most recent market for the commercial exchange of human components: new reproductive technologies. The purpose is to explore the normative and ethical foundations upon which human markets are currently based and to extend these to a consideration of the consumer policy issues that will affect the burgeoning growth in novel reproductive markets. In particular, the sacred and profane aspects of using reproductive technologies to alleviate childlessness will be addressed, as well as their relevance to more traditional approaches to infertility, such as adoption. Markets for Human Blood In his seminal book, The Gift Relationship, Titmuss (1970) describes in detail the ethical and economic underprintings of two markets for human blood--that based upon the altruistic gesture of providing one's blood for transfusion (usually) to strangers and the other based upon selling one's blood to a commercial blood bank. Titmuss strongly advocates the enforcement of altruism as the only mechanism for meeting the medical demand for blood, arguing that the presence of a commercial blood supply acts to devalue the human gift of blood. To Titmuss, the value of enforced altruism in a society greatly exceeds the economic benefit for some members of that society who would choose to sell their blood. In essence, his argument rests upon maintaining a distinction between sacred products (such as blood) and profane products (such as automobiles). Sacred products, he proposes, must only be given to others, never sold, because the presence of a commercial market in sacred products could destroy the presence of altruistic donations of these same products, i.e., why should someone give away that which can be sold? In rebuttal to Titmuss' position, Hough (1978) argues that there is nothing inherently unique about blood as a commodity. In his view, people sell other aspects of themselves (e.g., cognitive abilities, physical effort), hence why should human tissues and organs be exempt from commercialization? Hough maintains that "by assigning a price to blood, and efficient allocation of blood resources within the medical industry can be maintained" (1978, 27). He further proposes that the concurrent existence of a commercial market for blood will not necessarily inhibit altruistic donations. Rather, he argues, the decline in such donations may simply reflect the breakdown of communal ties in modern society. The ethical arguments regarding transfers of human blood largely are reiterated within discussions of policy issues surrounding markets for human organs, but additional issues arise. There are essentially two sources for transplantable human organs: cadavers and living donors. The major source, cadavers, presents some ethical problems in that, first a reliable means of establishing death prior to organ deterioration must be agreed upon; and second, the family ofthe deceased must agree to permit the organs to be harvested for transplantation (Simmons, Klein, and Simmons 1977). …