Ethics Committee of the American Society for Reproductive Medicine. Financial incentives in recruitment of oocyte donors

Alignment between expectations and experiences of egg donors: what does it mean to be informed?

This study evaluated the retrospective perceptions of egg donors regarding information communicated about immediate and long-term risks during the process of becoming an egg donor, and the alignment of that perception with their experiences and expectations of egg donation. Data were collected using an anonymous online survey. Egg donors' demographics, perceptions of being informed about immediate complications and long-term risks, and alignment between their expectations and experiences were analysed. In total, 375 current and former egg donors participated in an online survey about their decisions and experiences. Participants ranged in age from 18 to 57 years, with a median age of 24 years at first donation for compensated donors. The majority of the participants (81%) provided eggs in the USA, and 86.1% reported being compensated beyond direct reimbursement. Overall, 66% of egg donors surveyed reported feeling that their experiences matched their expectations based upon what they had been told during the informed consent process. While most participants (64.8%) felt well informed about potential short-term risks, 55.2% did not feel well informed about potential long-term risks. The findings indicate that while the majority of egg donors felt informed about immediate complications, there are gaps in knowledge about potential long-term risks. Results from this research provide insight into how egg donors understand risks and benefits, and can be used to improve counselling and informed consent forms and processes. The findings also indicate that longitudinal research on the health and well-being of egg donors is needed in order to improve informed consent.

Patient health incentives: ethical challenges and frameworks

BACKGROUND

Patient incentives for encouraging healthy behavior raise a number of ethical concerns: Do they target the vulnerable? Do they involve psychological manipulation? Do they undermine intrinsic motivation?

PURPOSE

To the purpose of this paper is to provide an overview of ethical challenges raised by patient incentives and incentive programs and develop a systematic approach to understanding and analyzing these ethical challenges.

METHOD

Ethical considerations raised by patient incentives can be broadly grouped into two kinds: medical ("patient-oriented") and public health ("constituent-oriented") concerns. Ethical frameworks suitable to these kinds of concerns are explored.

RESULTS

Two ethical frameworks are applied to the challenges raised by patient incentives: (1) Incentives are assessed in terms of personal and social responsibility for health; and (2) incentives are assessed as elements of normatively structured clinical relationships (e.g., the traditional patient-clinician relationship).

CONCLUSION

A better understanding of ethical concerns and the resources available within the personal responsibility and clinical encounter frameworks suggest complementary guidance may be available for approaching many of the ethical issues raised by patient incentives.

The ethics of creating children with three genetic parents

This article on mitochondrial replacement technology briefly explains and defends the legitimacy of such terms as 'three-parent embryos', 'three-parent babies' and 'three-person IVF'. Next, it reviews select ethical objections to mitochondrial replacement technology that fall into four, sometimes overlapping, categories: (i) harms to egg providers; (ii) harms to potential offspring and future generations; (iii) harms to specific interest groups; and (iv) harms to society. Taken together, these ethical objections are cause for serious concern and yet the development and future use of mitochondrial replacement technology is likely inevitable.

Transnational trade in human eggs: law, policy, and (in)action in Canada

In this paper, we provide as accurate a picture as possible of transnational trade in human eggs involving Canadians. We explain the legal status in Canada, and call for reform in the regulation, of such trade.

Attitudes towards gamete donation among Swedish gynaecologists and obstetricians

BACKGROUND

Assisted reproductive technology (ART) legislation in Sweden has undergone a gradual transformation from being fairly restrictive when first introduced to becoming more permissive in recent years. Regarding gamete donation, Sweden became the first country to pass legislation about disclosure by establishing a child's right to find out the identity of the gamete donor once the child has reached maturity. Our aim was to investigate attitudes towards gamete donation among Swedish gynaecologists and obstetricians.

METHODS

A questionnaire was mailed to all gynaecologists and obstetricians listed from a commercial register of all working in Sweden. Among 1230 eligible gynaecologists/obstetricians, 854 (69%) answered the questionnaire.

RESULTS

In general, the majority of Swedish gynaecologists/obstetricians had positive attitudes towards gamete donation. Although a majority advocated openness regarding informing the child that he or she was conceived by making use of gamete donation, approximately 40% opposed allowing the child to receive any information about the donor when the child has reached maturity. Even though Swedish legislation has allowed sperm donation to lesbian couples since July 2005, one-third of the gynaecologists/obstetricians opposed donation to lesbians.

CONCLUSIONS

The results indicate that the gynaecologists'/obstetricians' negative attitudes towards disclosure may influence patients' ability to discuss their thoughts and feelings about donation. This may also have a negative impact on donor recruitment as well as on the extent of methods made accessible within ART.