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Markets-Dignity
Carolina Puga[1]
Sociologist specialized in
migrations The little seed issue
Where do kids come from? The question which little by little had started to become easier for parents to answer has turned again into a difficult matter.
Kids can come either from the sexual union of mum and dad or their non-sexual union, meaning for example their ovules and spermatozoids joined in an In vitro fecundation, or else the mother and a semen donor, the father and an ovule donor, two donors and the mother’s womb, two donors and a third woman who lent us her uterus…
The new and not so new guidelines on reproduction burst into our society nowadays with a strength which responds not only to scientific progress but also to demographic problems . They are socially accepted, legally legitimated and part of many of the services offered by lots of public sanitary systems.
The vertiginous way in which the procedures and possibilities have grown (not only for the ones who want to be parents but also for those who can think of a donation) as well as the decisions to be taken at a political, juridical and economical level, have turned the revision of its terms into a necessary, permanent but also urgent task. The problems and proposals of these new options exceed the mere juridical or medical area and claim for other sectors’ commitment.
As an explosion, the old tale of the little seed has been decomposed into a multiplicity of different narrations whose main characters are not two or three any more. Social mums and dads, donors, subrogated mothers, doctors, scientists, the State, justice and, not to forget, girls and boys to be born conform a complex scenario presenting multiple possible angles. It is this article’s attempt to provide some elements and ideas allowing a serious and critical analysis we believe cannot wait.
Commercialization of human reproduction and medicine to satisfy the desire
Procreation processes through assisted reproduction have two main differences with procreation through the sexual union between a man and a woman: the first one is that the before mentioned procreation is non-sexual. Science and technology make in this way come true the omnipotent fantasy, which has always fed mythology and literature: procreation without sexual contact. But far from disappearing, sex has grown in importance (or at least keeps the one it used to have). It has blown into many particles and can be found everywhere: it is on TV, in magazines, it is the most searched word on the net, it is contemplated in public sanity, it also has specific sections in the newspaper and zones in cities… the social function of sex appears every time more independent of its reproductive function reaching this independence, so useful in the past, its limits.
Nowadays, procreation is not a matter of two people anymore and to carry out the assisted reproduction processes the necessity of a third person arises. Society, this third nominal which involves multiple actors, can adopt different positions regarding men, women or couples with impossibilities to procreate and demanding intervention. Strings can be pulled in favor of protecting ones more than others. Strong and vulnerable characters appear and the attempt to analyze each of them will possibly help us see the problem more clearly.
In the year 2000, the Council of Europe announced in its Bioethical Agreement that the human body and its component parts mustn’t be used with lucrative purposes.
Assisted Reproduction clinics have been rapidly growing in quantity not only in Spain or Europe but also in the rest of the globe. What has happened different from the past for this to occur? Are there more infertile women and men? Undoubtedly the demand for the services these clinics provide has also grown but we cannot directly attribute that to a growth of infertility. Neither can we attribute it to scientific progresses on this field since, (although vertiginous), they are previous to this phenomenon. For some reason, there are every time more places willing to offer (and people willing to demand) procedures that for the time being are not easy, unsafe and many times traumatic for the ones who experiment them.
The amounts of money these procedures imply are not to disregard at all. Assisted reproduction treatments are long and expensive (each treatment may cost 9000 Euros, needing in general more than one[3])
Finally, the language, eternal denouncer, tells us that the semen is kept in “banks”, the embryos are “products” and the movement from the test tube to the uterus is a “transference”.
These factors (and some others I will mention later on) seem to indicate we are witnessing how human reproduction is turning into a business[4].
The objective is not to look for somebody to blame or to create phantoms; on the contrary, it is about calling the professionals and not professionals working in this field to reflect in a deep, critic, serious and human way about their own place in the process and the process itself.
Health is many times used to make profits, and under that framework, reproductive health and its different fields can be also used for that sake.
Semen donation, ovocytes donation, artificial insemination, In Vitro fertilization, subrogated maternity and many others. It is impossible to deny that each of these concepts has its corresponding monetary value, independently from the justifications for that value (for the treatment, for the inconvenience of”, etc). So, it is about uncovering, about naming to liberate. Only once the mercantile aspect of assisted reproduction processes is assumed, and the concept of exchange in what, in the end, is the conception of a new being is recognized, will we be able to make a critical and conscious exam of everything that surrounds this fact.
Why are we urged to assume the commercialization of human reproduction? Firstly because the role of economical processes into assisted reproduction treatments is not negligible, therefore if we are going to talk about them, we must consider all its components and sides. Secondly and mainly because in our society, when given the conditions and the freedom to do so, any of these procedures can be turned into a business. In other words, only by assuming this undeniable reality and by adopting a position about it will we be able to try, if that is what we wish, to differentiate the hand which pulls the string in the market from the one which does it in the Assisted Reproduction procedures.
We are witnessing nowadays on the one hand, the magnification of genetics and medicine which seem to be almighty and, on the other hand, we see its most banal expression, its manipulation, and as we said before, its commercialization.
The crisis of certain values has subverted medical obligation of healing and protecting life to the mere satisfaction of individual desires or economical needs. The medicine to satisfy the desire, the one in favor of the most extreme individual will, characterized by an individual ethic, separated from its social role and many times capable of denying the importance the actors have in this process (the donors, the kids – this topics will be treated later on) is the medicine determined to do anything or almost anything in order to satisfy the desire. It is the medicine of the parts and not the whole.
The medicine to satisfy the desire is definitely not the medicine of subjectivity. Even when trying to satisfy an individual desire, this sort of practice does not take into account the personal history of the ones demanding the treatment or the reasons beyond the physical boundaries.
The medicine to satisfy the desire together with the before mentioned commercialization of human reproduction (concepts separated for analytical purposes but always connected to each other) turn medicine into a practice dealing with objects and place the woman and her body (beyond the fact that she is nominally the one demanding the intervention) in a vulnerable position.
Therefore, we are urged
to do a humanizing job in science as well as in medicine, based on
bioethical outlines and placing human dignity above all. Individual and
social dignity, but specially the global one we hardly ever talk about: our
dignity as specie. About the donors
All the procedures of Assisted Reproduction can be done heteronomously, that is to say with a gamete from the one who demands the treatment (either the woman herself or her couple) and another from a donor.
Due to its reproductive aim, ovule and sperm donation acquire a different status from other types of donations. It is one of the most controversial issues to be treated by bioethics since its consequences are not only long lasting but also…human.
What lies behind the donation of
sexual gametes? What is the donors’ social role? How well informed is the
person who gives the consent? What is expected with its anonymity? The
donors issue is central if we want to explore assisted reproduction fully.
Unlike what happens with the human reproduction being turned into a business,
the topic of donors and all it involves hasn’t been so carefully disguised,
so that we can find gaps and cracks from where to start knowing, recognizing
and revealing certain aspects in a deep way.
The moral background of donation
To start drawing a social function of the donor we should think: why are their gametes claimed? Their gametes are claimed either because the ones from a couple are not effective (cases of sterility from one or both parts or immunological incompatibility between the sperm and the vaginal secretions) or because there is no such couple (mother without a couple or with a couple of the same sex).
Anyway, and if we try to place ourselves in a position leaving the moral of nowadays aside, (something more than difficult but worth trying), in many cases the embryo resulting from the demanding part and the donor can be conceived without medical intervention. That is to say, for example, that a son, resulting from an artificial insemination of a fertile woman’s ovule and the semen of a donor, can be conceived through a simple sexual intercourse (frequent solution for male infertility in some primitive societies). The representations about sexuality and what they socially determine are beyond the aims of this analysis. We will only say that, from a certain point of view, some procedures of assisted reproduction seem to obey the same old patriarchal logics. It is under these logics that a wide net is created being its center the intervention of the feminine body. As we have already said, the treatment can be painful and stressing, apart from not being successful in most of the cases. Once the consent has been given, and it is pertinent to wonder how informed it is, the woman loses control of her own body and the new option could, from certain point of view, be transformed into oppression.
In this way, the donors´ function is not only signed by the fact of having what someone else needs (the ovules or spermatozoids) but also the mere fact of donating (and not giving it away in a different way such as sexual intercourse) would have a moral background.
Donation as an altruist fact
If we look at the other side, we find a question much more difficult to answer: what is the donor’s will? What desire is accomplishing when donating?
“The donor is accomplishing an altruist desire” would read the thought on which all the laws and policies ruling this issue are based. “It is a gesture of solidarity made real by the action of “giving away” something they “have in excess” and so, give the chance to become parents to those who are not able to”.
In March 1999 an advert published in the most prestigious universities of the United States offered 50.000 dollars (currently in Spain the payment is about 700 Euros) to the young lady who, meeting certain characteristics, would accept to donate her ovules. 200 women responded to that call by contacting the lawyers who had made the offer. This fact itself doesn’t say much except when we compare it with the only 6 altruists who had responded to the same advert five month before, when the amount of money rewarded hadn’t been mentioned[5].
Considering donation as an act of solidarity is the first crack we find when speaking about donors. If we compare it with, for instance, the donation of a kidney, we will also consider this last one an act of solidarity, even because the procedure to extract a donor’s kidney is much more complicated than the one to obtain an ovule, needless to say a sperm. Nevertheless, kidney donation is not remunerated in any case. It is also quite clear that in general, the altruist act of donating a kidney just before clinical death is due to affective bonds with the receptor, and no other thing is requested.
If we compare it with blood donation as well, much simpler but generally much more urgent than the one ovules or semen require, nothing is paid for it.
There are no doubts about the fact that in order to heal, our society needs more urgently and more amount of organ or blood donors than sexual gamete ones. So…why is money offered for the second ones and not for the first? Why is semen donation considered “a nuisance” and susceptible of being remunerated and not blood donation if both are equally altruistic acts? Why are the first ones being multiplied year after year instead of the second ones? Would young people donate their ovules for nothing when their own body is at stake? Six American university students said yes, would they be enough to carry on with an assisted reproduction clinic? ...
Sexual gamete donation as a purely altruistic act is definitely untenable. The truth is that the donors receive an amount of money never thought for other donations…and a hick of a lot less than what the claimants pay. It is the doctor or the clinic the one who mediates between this offer and this demand where the sexual gametes seem to be essential raw material to get to the product: embryo.
Despite of all this evidence,
medicine and law still consider donation as an act of solidarity. The
problem is that if we accept at least the possibility of the donor being
moved by economical interests, we would also have to think this character as
a vulnerable actor inside the process.
About the anonymity
Eyes color, weight, childhood illnesses, job, family history…everything can be known about a sexual gamete donor…everything except their name. Donor’s anonymity is maybe the darkest crack when analyzing assisted reproduction.
Beyond the problematic we are
dealing with, the secret regarding a certain topic (any topic), not at an
individual/personal level but at the institutional one is a delicate issue.
Even though institutional secrets exist and have always existed, they are
not generally incorporated into the policy system of the institution. In
this way, we can say in first place that the secret about the identity of
the sexual gamete donor appears: 1. As an institutionalized secret, that is to say anchored in the norms and rules of society and not in individual wills. 2. As a legitimized secret: accepted by justice and law, perceived as licit and genuine.
What is behind this secret? By being legitimist and mandatory its importance is shown. Why? Who is it for? What is so urgent and powerful to make this secret go beyond the individual control (parents who don’t want to tell their child) and become a law?
From the family’s point of view (this is from the parents demanding the treatment and the kid born), there is no reason to think about the necessity of anonymity. The secret (or not) about a kid’s origin has always belonged to the private sphere (let’s think for example about adopted children, children from a mother/father different from the one who raised them who are not revealed the truth) and there is no reason for it to stop belonging to that sphere.
From the donor’s point of view, it can be said that they have no intention to procreate…Can we think then, that the anonymity releases the donor from the effective biological procreation? Of course not. It can, however, release the donor from the consequences and responsibilities this fact may have in the future.
Anonymity, from the donor’s point of view, is a denying and childish resource to avoid taking responsibilities. The question is what would happen if donation weren’t anonymous any more…would all donors assume the responsibility of having to respond to people willing to meet their biological parents some years later?
Following the idea developed in the previous section, we may think that if donation is altruistic, the donor would be proud of having helped infertile parents to procreate…then, why would they want to hide themselves?
The truth is that revealing the donor’s identity would have the same consequence as not paying for donation: a fewer number of donors and the loss of our “raw material”.
Besides, the anonymity has a pretension: leave it and forget it. Nobody will know you have done it and you won’t know what has happened. The donor must be invisible.
We can’t certainly think that the consented secret releases each person from the ethical dimension: the reality is that young donors do become biological parents. The importance given to the existence of genetic descendants from donors depends on each society…but the descendants are there, they exist whether the name of the donor is known or not.
The question is now if it possible to accomplish this denying pretension. It is very difficult to think that in our societies, in which children occupy such an important place in projects, aspirations, social imperatives, etc, the fact of having genetic offspring is relegated and disregarded.
Ovule and semen donors are exposed to fantasies which may have disagreeable psychical consequences: not only fantasies of multi-paternity or multi-maternity and the related ones with possible embryos of oneself waiting to be born, but also and mainly fantasies of incest, considered taboo in most societies. As nothing assures, for example, that a couple of persons born from donated gametes are not siblings, nothing assures either that a couple with age differences hasn’t got genetic filiations. Though very unlikely, this possibility opens the door to fantasies which may psychologically damage an individual or even worsen an already existing problem.
In this way, the vulnerability of the donor’s figure is signaled by three factors: firstly, by the fact of receiving remuneration, secondly by the pretension of invisibility of their function and finally, by their exposition to fantasies of dubious healthiness.
Last but not least, their
right of genetic family identity is violated, not being allowed to find out
about their own possible offspring. This issue, however, will be deeply
developed in the next section. The child: voiceless subject
In the discussions about gametes donation there is a voice still unheard. The child, or better, the person resulting from donated gametes, is perhaps, the most vulnerable actor among the ones mentioned so far. Defenseless, with no voice or capacity to decide, the kid demands everybody’s commitment: to anticipate to their complaint and look after their interests.
The fundamental rights of the engendered child are scarcely or not contemplated by the law. The interest and safety of the underage are not over the rights of the people who come to donation to satisfy their “desire of a child”.
Following the logic of the commercialization of human reproduction, at least before being born; the kid-product is treated as an exchangeable object.
Since their right is not properly contemplated by the law, it isn’t guaranteed that the kid wouldn’t be discriminated for having a certain race or genre. This happens since parents can choose the physical features as well as the sex of the person to be born.
Neither is their mental health contemplated, since all the traumatic psychological processes the subject might have to go through when wondering about their biological origin (such as the before mentioned incestuous fantasy) as well as their social and juridical instability are not taken into account.
But undoubtedly, the main violated right regarding the subject to be born, is their identity right.
Ricardo Oppenheim describes the identity right as “the right every individual has of knowing how they were conceived, their genetic background and the possibility, in his case, to identify and locate those who brought them to life, either in a natural way or by contributing with reproductive material”[6].
The identity right of a kid can be violated in different ways: by changing their name, their age or neglecting them the possibility of knowing their own history, their origins…
With the anonymous donation of sexual gametes the right of genetic identity is firstly violated. Furthermore and not less important, the right of genetic family identity is also violated. That is to say, the right boys and girls should have to investigate the existence of possible biological siblings. This would also apply to the case of frozen embryos.
As we have already said, sexual gametes can be manipulated in such a way that the sex of the person to be born can be determined. The embryo’s sex can also be determined by extracting a cell, soon before being conceived, and changing it for another one to alter its sexual identity or invert it completely. In both cases, apart from the before mentioned sex election, the right of genetic sexual identity is being violated.
The law allows in this case a hole, the lack of the child’s history. The child’s history appears as a torn and empty one. It is a history which starts from scratch. The kid born from donated sexual gametes is a kid without genetic history. And what is more, it is a kid whose access to that history is neglected.
On the other hand, parents as well as donors are also deprived of the identity rights (to know the genetic history of their children and to find out about their offspring respectively). Having given the informed consent or being aware of the procedures and regulations in advance does not constitutes a relevant fact, since the possibility of a more digested decision or concern which grows throughout the time about this topic should be contemplated for the future.
The way in which the juridical and economical procedures in assisted reproduction are being carried out, may be putting the dignity of the kid to be born too much at stake. “Things –says Kant- have a price, men instead have dignity”[7] Dignity consists in being valuable for oneself and not because of the relationship with others and therefore, dignity means to claim and obtain an unconditional respect. It is dignity what protects us from becoming objects, products, or the mere fact of existing to satisfy other person’s desires…even when those others are our parents.
A subject who hasn’t been
born cannot be heard. It is not about talking for them, but guaranteeing
that the day they are born they are going to have at least, that dignity. As a conclusion
Many times, scientific progress makes us think about issues which in the past were naturally resolved. This is one of those cases.
Ethic must take over the market by installing a social debate with proper information within the society. All what was analyzed in this article, added to an absolute inequality in the access to assisted reproduction techniques (which destroys one more time the argument of altruism) indicates that the practice, processes and policies which surround the birth of these boys and girls is perhaps too influenced by economical and market interests.
The debate should not be devoted to judging the techniques or the market itself, but to express that many times market necessities can destroy other kinds of imperatives of vital importance. Giving priority to our values and our ethic becomes essential; otherwise, if we don’t reflect or act in favor of our priorities the loss will be huge.
The right for life and maternity should never be the right to generate life at any cost. Destroying the physical and mental health and the donors’ and children’s dignity is surely not what we want to as a society.
While some people think
the human being is not naturally good there are others like me, who think a
person can be good through their culture, being able to modify the life they
give to themselves and their relatives. Adopting a critical position implies
showing interest in this modification, which will have to be completely
conscious. Bibliography
[1] Carolina Puga is a sociologist specialized in migrations [2] Assited reproduction boom occurred simultaneously with the one in international adoption [3] Data obtained from the “Instituto valenciano de infertilidad” (IVI) www.ivi.es [4] The amount of money adoption requires nowadays can also be thought as part of this process. [5] Associació Catalana d’Studis Bioetics (ACEB). Campañas de donación de óvulos (editorial). June 2000. In: http://www.aceb.org/editoriales/0600_cs.htm. [6] Oppenheim, R. ¿De qué hablamos cuando nos referimos al derecho de identidad en los casos de fecundación humana asistida? In: Minyerski, N. “Adopción y procreación asistida”. Exposed in the First National Conference of Bioethics and Law. Buenos Aires 2000 [7] Kant, E. In: Martínez Sospedra, M. “Los niños terapéuticos” In: El Páis, Comunidad Valenciana 25/5/2004 |
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