Monday, November 24, 2008

Singapore and compensation for organs and eggs

The National Bioethics Committee in Singapore has been pretty busy lately. At the start of November, the Singapore Ministry of Health announced a change to the Human Organs Transplant Act (HOTA), and the National Bioethics Committee publicly endorsed the revised law soon afterward. Just days later, the Committee released guidelines on the donation of female eggs for research. And one of the central ethical issues in both cases concerns compensation and inducement in the context of exchanging human biological materials.

Should donors of organs or eggs receive some sort of compensation for their act of giving, or should it be a pure act of altruism? Should organ or egg exchange be a market-force driven transaction like any other -- like the buying and selling of cars -- or should these exchanges have a special, non-commercial status in keeping with the dignity of human beings? Positions in this domain often get polarized into the kinds of extremes that the media love: on the one hand, libertarians and utilitarians who think people ought to be able to do what they want with their body parts (including selling them), and that this sort of freedom is the ultimate solution to demands for organs and eggs. On the other hand, some believe that only the most restrictive laws are in keeping with the special status of our species, even if this comes with the cost of diminishing the supply of useable organs and eggs (for some members of that same species). For those unconvinced by the concept of 'dignity', there is also the consideration that wherever paid organ exchange takes place, the exchange from donor to recipient tends to channel along the lines of social injustice, i.e. from the poor to the rich, from women to men, and from non-Caucasian to Caucasian.

The Singapore approach involves a tricky distinction between compensation and (undue) inducement. The National Bioethics Committee is of the opinion that organ and egg donors should compensated for the costs to themselves involved in the act of donation, including loss of time and earnings, the burden of physical and psychological risks, transport and medical costs, including follow-up medical expenses and (in the case of organ donors) possible higher insurance premiums. Determining a fair level of compensation in general would seem to be very difficult, given that there will be diversity in (among other things) economic status between recipients and donors. The Committee wants to discourage people from seeing the donation of their organ and eggs as a for-profit activity -- even if third-parties do make money out of it -- while also avoiding placing an unfair burden on donors. The result will probably displease those on both ends of the bioethics extremes, but that is usually a sign of health when it comes to regulations.

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