Klitzman Robert L, Sauer Mark V
Masters of Bioethics Program, Columbia University, New York, NY.
Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology, College of Physicians & Surgeons, Columbia University, New York, NY.
Am J Obstet Gynecol. 2015 Aug;213(2):186-187.e1. doi: 10.1016/j.ajog.2015.03.046. Epub 2015 Mar 26.
A recent lawsuit that alleges that the American Society for Reproductive Medicine (ASRM) engages in price-fixing by capping the amount of compensation paid for human oocytes has several critical ethical and policy implications that have received relatively little attention. ASRM has argued that ceilings on donor compensation prevent enticement, exploitation, and oocyte commodification. Critics counter that low donor compensation decreases supply, because fewer women are then interested in donating, which then increases prices for the service that physicians, not donors, accrue, and that ethical goals can be better achieved through enhanced informed consent, hiring egg donor advocates, and better counseling and screening. Yet, if compensation caps are removed, questions emerge concerning what the oocyte market would then look like. Informed consent is an imperfect process. Beyond the legal and economic questions of whether ASRM violates the Sherman Anti-trust Act also lie crucial questions of whether human eggs should be viewed as other products. We argue that human eggs differ from other factory-produced goods and should command moral respect. Although eggs (or embryos) are not equivalent to human beings, they deserve special consideration, because of their potential for human life, and thus have a different moral status. ASRM's current guidelines appear to address, even if imperfectly, ethical challenges that are related to egg procurement for infertility treatment. Given public concerns about oocyte commodification and ASRM's wariness of government regulations, existing guidelines may represent a compromise by aiding patients who seek eggs, while simultaneously trying to avoid undue influence, exploitation, and eugenics. Although the ultimate outcome of this lawsuit remains unclear, policy makers, providers, lawyers, judges, and others should attend seriously to these issues. Alternatives to current ASRM guidelines may be possible (eg, raising the current caps to, say, $12,000 or $15,000, potentially increasing donation, while still avoiding certain ethical difficulties) and warrant close consideration. These complex conflicting ethical issues deserve more attention than they have received because they affect key aspects of clinical practice and the lives of countless patients.
最近有一起诉讼指控美国生殖医学学会（ASRM）通过限制人类卵母细胞的补偿金额来进行价格操纵，这引发了几个关键的伦理和政策问题，但相对而言受到的关注较少。ASRM辩称，对捐赠者补偿设置上限可防止诱惑、剥削和卵母细胞商品化。批评者反驳称，低捐赠者补偿会减少供应，因为愿意捐赠的女性会减少，这会导致医生（而非捐赠者）所提供服务的价格上涨，而且通过加强知情同意、聘请卵子捐赠倡导者以及更好的咨询和筛查，能更好地实现伦理目标。然而，如果取消补偿上限，就会出现关于卵母细胞市场届时会是什么样子的问题。知情同意是一个不完善的过程。除了ASRM是否违反《谢尔曼反垄断法》的法律和经济问题之外，还存在人类卵子是否应被视为其他产品的关键问题。我们认为，人类卵子不同于其他工厂生产的商品，应得到道德尊重。尽管卵子（或胚胎）不等同于人类，但由于它们具有孕育人类生命的潜力，因而值得特殊考虑，因此具有不同的道德地位。ASRM目前的指导方针似乎在应对与不孕症治疗中卵子获取相关的伦理挑战，即便并不完美。鉴于公众对卵母细胞商品化的担忧以及ASRM对政府监管的谨慎态度，现有指导方针可能是一种折衷方案，既能帮助寻求卵子的患者，同时又试图避免不当影响、剥削和优生学。尽管这起诉讼的最终结果尚不明朗，但政策制定者、提供者、律师、法官及其他人士应认真对待这些问题。现行ASRM指导方针的替代方案或许可行（例如，将当前上限提高到12000美元或15000美元，这可能会增加捐赠，同时仍避免某些伦理难题），值得密切关注。这些复杂且相互冲突的伦理问题应得到比目前更多的关注，因为它们影响着临床实践的关键方面以及无数患者的生活。
