20 - Ethical aspects of controversies in assisted reproductive technology

Summary

Many ethical dilemmas are raised by assisted reproduction as we are confronted by our intuitive understanding of whether it is right or wrong to offer treatment, refuse treatment or perform research, often in a context of possibilities that could barely have been contemplated in the recent past. This chapter is intended to give an overview of just some of the ethical aspects of controversies in assisted reproductive technology (ART) and hopefully to enable insight into others arisen and those yet to arise.

Issues in gamete donation

The two main issues are payment or donation (a misnomer if indeed payment is offered) and the question of donor's anonymity. The interests of the donors of gametes are also an ethical issue (Shenfield, 1998).

Payment or compensation to donors

The semantic argument (Shenfield & Steele, 1995) is that a donation of gametes and embryos should be free, otherwise the term ‘donation’ would be ‘sale’. The counter-argument is that in practice there are difficulties matching supply to demand, especially in the case of oocytes, and should pragmatism not prevail in a scarce supply environment? In the United Kingdom (UK), the law states that ‘no money or other kind of benefit shall be given or received in respect of any supply of gametes or embryos unless authorised by directions’ (Human Fertilisation and Embryology Act 1990). The notion of a gift is also enshrined in law in France and Spain (Shenfield, 2001).

The ethical argument against payment might be Immanuel Kant's assertion that one must ‘treat all humanity always at the same time as an end and never merely as a means’ (Kant, trans. 1993).