## 1. The Rights and Duties of Gamete Donors



The rights and responsibilities that attach to parenthood are
generally understood to be very weighty. Consequently, determining
whether or not gamete donors are parents is a question that has
attracted much attention. But even if gamete donors are not parents in
the deeper ethical sense, they may still have considerable rights and
obligations towards their biological offspring. While there is
considerable overlap here with the parenthood literature (see the entry on
 parenthood and procreation)
 questions about parenthood in the context of gamete donation have
garnered much specific attention. In what follows we will examine
three distinctive questions that have emerged: (1) Are gamete donors
parents? (2) Can parental responsibilities be transferred to others?
(3) Do gamete providers acquire any non-parental obligations?


### 1.1 Arguments in Favour of Gamete Donor Parenthood



A common starting point for the claim that gamete donors acquire
parental responsibilities is to highlight the strong intuitions we
have about parenthood in cases other than gamete donation. Normally we
think that those who wilfully engage in procreative acts acquire
parental obligations if children are created as a result. This is true
even when procreation is unintended, due to faulty contraception for
example. The strength of this intuition is used as motivation for
adopting a causal view of parental obligations. On such views,
creating offspring in the right kind of way is sufficient for the
acquisition of parental responsibilities. Those who think that gamete
donors have parental obligations proceed by arguing that the most
plausible causal accounts of parenthood must include gamete donors
(Nelson 1999; Fuscaldo 2006; Blustein 1997).



For instance, Nelson argues that our common-sense understanding of
moral responsibility is what best explains our intuitions about
parenthood following unintentional procreation. On the common-sense
view, individuals are morally responsible for the consequences of
their free actions when (1) their actions are sufficient to bring
about those consequences, and (2) their actions are causally proximate
to the consequence in question. Gamete donors satisfy these
conditions. Nelson further argues that gamete donors' causal
involvement in creating children does not significantly depart from
that of unintentional parents (at least not in morally relevant
respects) and therefore consistency demands that gamete donors be
ascribed parental responsibilities as well (Nelson 1999, 2014). 



Another route is to argue that reproduction is a special kind of case,
and that special rules apply when determining what moral
responsibilities arise for reproducers. Consider for example what
David Benatar (1999) calls 'reproductive autonomy'.
Benatar argues that individuals' reproductive autonomy both
entitles them to make reproductive decisions, and requires them to
take responsibility for the consequences of those decisions. He argues
that this is a special feature of our ability to reproduce that is not
fully reducible to genetics or mere causality, and results in a
presumptive duty to parent the children created from our gametes.
This, he argues, best explains why parental responsibilities arise in
accidental pregnancy cases. Though in some circumstances the
presumptive duty to parent one's genetic children may be
overridden, this is not the case for most instances of gamete
provision (Benatar 1999). 



One worry about Benatar's argument is that it relies heavily on
stipulating that unique moral features attach to reproduction, and so
risks begging the question. Rivka Weinberg (2008) offers an argument
for a similar conclusion, but on more general grounds. Weinberg argues
that when individuals exercise control over materials that pose grave
risks to others (what she calls 'hazardous materials')
they are liable for the consequences that arise, regardless of the
precautions they take. For instance, the owner of a pet lion is liable
for damage done by the lion regardless of the precautions the owner
takes to keep the lion contained. Calling this the "Hazmat
Theory", Weinberg argues that it applies to gametes because
their use can have morally weighty consequences for third parties
- namely the children that may result from the union of gametes.
Consequently, Weinberg argues that gamete providers are obliged to
care for the children that result from the voluntary use of their
gametes (Weinberg 2008). 



Importantly, none of the preceding arguments rely on genetic
relatedness as grounds for parenthood. It is not the genetic
similarity between gamete donors and their biological offspring that
is doing the work, but rather considerations about the kind of thing
gametes are (things that can create people) and how gamete donors use
them.



David Velleman (2005, 2008), however, does argue that being parented by
close genetic relations is of great importance to the wellbeing of
children, and that for this reason we ought to be sceptical of the
ease with which society permits the separation of social parenthood
from biological parenthood. 


### 1.2 Arguments Against Gamete Donor Parenthood



Those who argue that gamete donation does not result in parental
responsibilities find fault with causal accounts of parenthood. One
prominent move is the 'too many parents' objection. The
core of this objection is the claim that causal theorists have no
principled way to distinguish members of the causal chain who acquire
parental responsibilities from those who ought not be ascribed such
responsibilities. As a result, causal accounts ascribe parenthood to
too many people. 



For instance, Tim Bayne (2003) argues that both Benatar and Nelson are
committed to including biological grandparents and great grandparents
etc. amongst those who acquire parental responsibilities for
donor-conceived children. Bayne thinks Benatar is committed to this
conclusion because subsequent generations are the result of an
individuals' exercise of reproductive autonomy. He thinks that
Nelson is committed to this conclusion because biological grandparents
and great grandparents are necessary causes of their donor-conceived
children, and so satisfy Nelson's criteria for parenthood.



It is however unclear whether Bayne's criticism is apt.
Nelson's account does rely on causal proximity, but he
explicitly rejects the view that merely being a necessary part of a
causal chain that results in the creation of a child is sufficient for
parenthood (Nelson 1991, 53). The actions of intervening agents
plausibly restricts the scope of individuals who are causally
proximate. 



And Benatar's view does not ascribe obligations for all the
downstream consequences of one's exercise of reproductive
autonomy. Indeed, autonomous control over the use of particular
gametes is an important feature of Benatar's account.
Grandparents and great grandparents do not normally possess autonomous
control over the use of their offspring's gametes, and so would
not normally be parents on this view. 



Jason Hanna (2019) advances a better version of the objection. Hanna
argues that medical professionals do exercise control over gametes and
are proximate causes of the children created through their use. After
all, medical professionals often perform the critical steps necessary
for conception. Indeed, in many cases medical professionals are more
causally proximate and exercise more control over the creation of
children than gamete donors. Consistency thus demands that at least
some of the medical professionals involved in gamete donation be
ascribed parenthood. According to Hanna, the most promising way for
causal theorists to escape this reductio is to accept that causal
responsibilities do not extend to cases in which: (a) one individual
acts for the sake of another in an employee/employer type relationship
and (b) that individual has reasonable assurances that the employer
will ensure that any obligations arising from their actions will be
fulfilled. This move has intuitive appeal. We do not think that an
employee whose assigned task produces pollutants has a special
responsibility to clean up those pollutants if her employer fails to
do so as promised. Hanna notes that this limit on the scope of causal
responsibility insulates gamete donors from weighty obligations
because gamete donors provide services for commissioning parents in
something like an employee/employer relationship. 



Elizabeth Brake advances another challenge to causal views of
parenthood. Brake (2005, 2010) argues that we are mistaken to think
that being causally involved in creating offspring suffices for
acquiring parental responsibilities. According to Brake, many of the
social practices that causal theorists appeal to, like child
maintenance obligations in accidental pregnancy cases, are in fact
mistaken. Brake argues that instead, we ought to be voluntarists about
parenthood. This does mean that those who cause children to exist are
free from obligations altogether. Brake argues that we ought to
distinguish between what she calls 'procreative costs' and
the more demanding obligations of parenthood. While causal actors may
be responsible for procreative costs, they certainly do not have
parental responsibilities. More will be said about Brake's
procreative costs in
 section 1.4



### 1.3 The Transferability of Parental Responsibilities



One way we might sidestep concerns about the parental status of gamete
donors is to argue that parental responsibilities can be transferred
to others. If such transfers are possible then presumably gamete
donors do so when they make their gametes available to others. That
such transfers are at least sometimes possible is a view that is held
by many (O'Neill 1979; Bayne 2003; Fuscaldo 2006; Benatar
1999). Those who defend the transferability of parental
responsibilities argue that parents often transfer some of their
responsibilities to others, such as school teachers, nannies, and
doctors. So long as gamete donors have reason to believe that those to
whom the responsibilities are transferred will do an adequate job,
such transfers are unproblematic. On this view, we ought to treat
gamete donation as a comprehensive transfer of responsibilities that
is no different in kind from these other commonplace transfers of
responsibility. However, accepting the transferability of parental
responsibilities does not imply that current practice is morally
permissible. We might think that many gamete donors fail to take the
necessary steps to ensure that their biological offspring will be
adequately reared (Benatar 1999). 



The transferability of parental responsibilities is however
controversial. Many argue that the move from some transfers of
responsibility to the complete abdication of parental responsibility
is too quick (Velleman 2008; Weinberg 2008; Nelson 1991; Brandt 2016).
For instance, Velleman (2008) argues that while adoption is acceptable
when there is no other means to provide a child with an adequate life,
this should not be confused with the intentional creation of children
whose social link to their genetic parents will be severed. Because
Velleman believes that preserving the social connection between
children and genetic parents is important for the wellbeing of
children, he argues that, unless there is pressing reason to do
otherwise, children ought to be parented by their genetic
progenitors.



Weinberg (2008) argues that parental responsibilities cannot be
transferred in full because certain kinds of intimate responsibilities
can only be fulfilled by particular individuals: individuals in the
right intimate relationship. For instance, parents cannot transfer the
obligation to celebrate their children's achievements to others
by having strangers attend their children's music recitals or
award ceremonies. Weinberg thinks that gamete donors have a
responsibility to love their children and that the responsibility to
love a particular person is paradigmatic of the kind that cannot be
transferred. Consequently, at least some parental responsibilities are
not transferable.



Brandt (2006) disputes the claim that partial transfers of parental
responsibilities are commonplace. When a responsibility is delegated
but not transferred, the individual delegating the responsibility must
still ensure that the responsibility is fulfilled. For instance,
parents have a duty to ensure that their children are in fact
receiving proper education from their teachers, and must take
corrective measures if this is not the case. The duty to educate is
thus delegated to teachers, but not transferred to them. In general, the
examples offered to show that partial transfers of parental
responsibility are commonplace tend to be in fact examples of
delegation. This undermines the claim that a complete transfer of
parental responsibility is merely an extension of already accepted
practices because it is delegation that is the norm, not transfer.



### 1.4 Non-Parental Responsibilities



Even if gamete donors are not parents, they may still have substantial
obligations towards their offspring. Bayne (2003) argues that gamete
donors have the responsibility to prevent certain kinds of lives from
coming about. For instance, they may be obliged to refrain from
creating children with severe congenital diseases that would result in
a 'life not worth living'. Many authors (Bayne 2003;
Archard 2010; Porter 2014; Fuscaldo 2006; O'Neill 1979, Brandt
2016) also think that gamete donors must take steps to ensure that
their offspring will be parented in at least a minimally acceptable
manner.



While the preceding responsibilities concern pre-conditions for the
permissible transfer of gametes, there might also be donor
responsibilities that extend into the lives of donor-conceived
offspring. For instance, as noted above, Brake (2005, 2010) argues
that gamete donors might have an ongoing duty to ensure that their
biological offspring receive a minimum level of care (she calls these
'procreative costs'), but that this should not be confused
with parental responsibilities, which are more intimate and more
morally weighty in nature. Likewise Brake, Porter (2012, 2014) and
Brandt (2016, 2020) similarly argue that gamete donors must continue
to take steps to ensure that their offspring have a decent life,
though they are not necessarily obligated to parent their offspring
themselves. 



There are reasons to think that these responsibilities do not go far
enough. For instance Prusak (2011) argues that the gap between
Brake's 'procreative costs' and parental
responsibility is not as pronounced as it initially appears.
Consequently, for all practical purposes gamete donors have
responsibilities edging on full blown parenthood. Conversely,
arguments originating in the abortion literature imply that gamete
donors need only ensure that their offspring have lives worth living.
For a discussion of these arguments and a response see Brandt (2020).




Another kind of non-parental obligation that gamete donors might have
is to remain open to the possibility of forming relationships with
their biological offspring, though this openness does not entail an
obligation to in fact form such relationships (Little 1999; Kolodny
2010). 


### 1.5 Offspring Limits



In addition to obligations that focus on the wellbeing of potential
offspring and the competence of intending parents, another question is
whether there ought to be limits on the number of offspring that can
be created from a single gamete provider. This question is most
significant in sperm provision because of the relative ease of
creating large numbers of children from the gametes provided by a
single individual. Three major justifications have been offered for
offspring limits: the risk of accidental consanguineous relationships,
the likelihood of convoluted social relationships with kin, and
general social discomfort with large offspring numbers (Wright 2016).
While the last might not be a plausible justification on its own, it
is worth mentioning because in practice such concerns have had an
influential role on imposed offspring limits (Deech 1998; Warnock
Report 1984).



Limiting offspring numbers in order to reduce the likelihood of
accidental consanguineous relationships between offspring of the same
donor was initially proposed by individuals concerned about possible
risks of congenital disease (Curie-Cohen 1980). Recent work has
attempted to quantify these risks (De Boer et al. 1995; Wang et al.
2007). While the increased risk of congenital disease resulting from
unintentional consanguinity is dependent on the size of the population
served by a sperm bank, the risk is lower than might be initially
thought. For instance, Dutch models suggest that an offspring limit of
up to 25 would not result in any significant increased risk, given
their particular demographic makeup (De Boer et al. 1995). However,
there is also the risk of psychological harm for individuals that
discover they have unwittingly entered into a consanguineous
relationship, given the associated social taboos (Wright 2016).
Furthermore, there may be legal complications if an accidental
consanguineous marriage is discovered after the fact (Cahn 2009a). One
way to mitigate these risks without imposing offspring limits would be
to increase openness in gamete provision, including actively informing
individuals about the identity of their genetic siblings. However,
even in the absence of such measures there is little agreement about
how the risks associated with consanguinity should be translated into
offspring limits, especially given the broad reproductive freedom
individuals are generally afforded (Wright 2016; HFEA 2011).



The main worry in relation to social relationships with kin is that
initiating and maintaining relationships with progenitors and/or
genetic siblings is made much more challenging if there are large
numbers to accommodate. The extent to which this justifies offspring
limits will depend on the importance placed on such relationships and,
as noted previously, there is much disagreement about this.
Furthermore, some empirical research into kin relationships following
gamete provision has found that having large numbers of genetic
siblings is not necessarily an impediment to the formation of
meaningful relationships (Freeman, Jadva, & Slutsky 2016).


## 2. Donor Anonymity



There is general agreement that it is permissible for donor-conceived
individuals to have information about and contact with their genetic
progenitors. However, gamete donation arrangements in which there is
an expectation that donors remain anonymous are more contentious. 



Advocates of children's rights to access identifying information
about their donors generally appeal to harms that might arise in the
absence of such information, and/or a purported fundamental right to
information about one's genetic origins (Ravitsky 2010, 2012;
Velleman 2005, 2008; McGee, Brakeman, and Gurmankin 2001; Blyth and
Farrand 2004). Possible harms considered include psychological
distress, damaged familial relationships, reduced self-knowledge, and
incomplete or incorrect medical records. Those who favour permitting
anonymous donation argue that it is a mistake to place a great deal of
importance on genetic origins, and question both the severity of the
harms caused by anonymous donation and whether the existence of such
harms constitutes a decisive argument against donor-anonymity
(Melo-Martin 2014; Haslanger 2009).



The philosophical debate takes place within a background of changing
legal norms governing donor anonymity (Clark 2011; Frith 2001;
Bernstein 2010). While maintaining donor anonymity was once common
practice (and is mandatory in certain jurisdictions, such as France)
there has been a strong trend towards enshrining in law
donor-conceived children's rights to access identifying
information about their donor, at least once they reach the age of
majority (Clark 2011; Frith 2001; Bernstein 2010; Brunet and Kunstmann
2013). 


### 2.1 Psychological Distress and Self-Knowledge



One reason for prohibiting anonymous gamete donation is the distress
that advocates of disclosure claim many donor-conceived children
suffer as a consequence of the absence of identifying information
about their biological progenitors. This distress is sometimes
referred to as 'genealogical bewilderment', a term
originally coined in reference to the distress experienced by
adoptees, and its symptoms are said to include difficulty developing a
personal identity that feels genuine, anguish about not knowing the
identity of one's genetic relations, and an obsession with
trying to find out information about one's genetic relations
(Sants 1964; Cahn 2009b). Advocates of the right to know point to both
scientific studies and general social observations, such as the rise
of services to help donor-conceived individuals find their biological
relations, as evidence of the severity of this harm (McWhinnie 2001;
Frith 2001; Ravitsky 2010).



A related argument is that donor-conceived individuals are denied an
important good if they are not given access to detailed information
about their biological relations. More than simply satisfying
curiosity, some argue that knowledge about one's biological
relations (especially through contact) is important for self-knowledge
(Velleman 2005, 2008). On this view, while a name and biographical
details may not replace being reared by biological relations, they do
at least provide donor-conceived individuals with *some*
information, and make contact later in life possible.



However, both these arguments have been challenged on empirical and
philosophical grounds. While some studies do indeed show that a subset
of donor-conceived individuals suffer psychological distress from not
knowing the identity of their progenitors, others show that such
distress is not common, and is not particularly severe when it does
arise (Melo-Martin 2014; Haslanger 2009). Studies also show
that early disclosure helps children incorporate the fact that they
were donor-conceived into their identity and sense of self, thus
helping donor-conceived children avoid some of psychological harms
associated with genealogical bewilderment (Golombok et. al. 2002).
Advocates of the permissibility of donor anonymity thus argue that
there is no clear evidence that donor anonymity is likely to result in
severe harm to offspring. If anything, the evidence suggests that we
should have a policy of early disclosure.



Furthermore, some argue that any psychological harm that does arise is
likely socially constructed. As evidence, they point to studies
showing that individuals who are unaware that they were
donor-conceived do no worse than their peers when it comes to
psychological wellbeing (Melo-Martin 2014; Haslanger 2009).
Consequently, they argue that any psychological harms experienced by
donor-conceived individuals arise in virtue of the social importance
placed on biological ties rather than any 'necessary'
deficit arising from being reared by individuals who are not genetic
relations. Similar arguments have also been raised in response to
Velleman's views regarding the value of contact with genetic
relations for self-knowledge (Haslanger 2009). 



If the psychological harms arising from donor-anonymity are socially
constructed, then prohibiting anonymous gamete donation may exacerbate
the harms suffered by donor-conceived children. This is because such a
prohibition could further reify the importance of biological ties
(sometimes referred to as 'biologism'), which is what
gives rise to the harm in the first place (Melo-Martin 2014;
Leighton 2014; Haslanger 2009). By signalling the importance of
biological ties, prohibiting donor anonymity might further stigmatize
those raised by non-biological parents.



However, that a harm is socially constructed does not make it any less
real, or less in need of redress. This results in a difficult bind for
those who agree that the harms are socially constructed. They are left
having to balance the interests of donor-conceived offspring with the
broader social goal of eliminating unjust socially constructed harms.
The best way to go about doing so is unclear (Haslanger 2009).


### 2.2 Medical Records



Another reason offered for prohibiting anonymous gamete donation is
that it prevents donor-conceived individuals from making health
decisions informed by family medical history. If individuals are not
informed about being donor-conceived, they risk making medical
decisions on the incorrect assumption that their social family's
medical background reflects their own. And even if such individuals
are informed that they are donor-conceived, they still suffer from an
absence of medical information that is generally available to others
(Ravitsky 2012). While it is true that medical information could be
provided at the time of donation in a manner that preserves the
anonymity of the donor, some argue that, as our understanding of
congenital disease changes, new information is likely to become
relevant (Leighton 2014; McGee, Brakeman, & Gurmankin 2001).
Additionally, certain relevant medical conditions might only become
apparent long after the donation. While a system could be put in place
for donors to update their medical information, some argue that such a
system would likely be too cumbersome for donor-conceived individuals
to receive the medical information they need in a timely fashion
(McGee, Brakeman, & Gurmankin 2001).



However, those who defend the permissibility of donor anonymity argue
that the value of medical history is overstated, and will become less
important as we move towards personalized medicine (Melo-Martin
2014). In fact, in a report recommending *against* permitting
donor anonymity, the UK's Nuffield Council on Bioethics stated
that medical interests alone were not sufficient grounds for
prohibiting donor anonymity (Nuffield Council on Bioethics 2013).


### 2.3 Family Cohesion



Another argument against donor anonymity is that secrecy about origins
has the potential to damage the relationships between donor-conceived
children and their social parents, especially in cases where the
social parent(s) know the identity of the gamete donor(s) Some argue
that the strain of having to 'keep the secret' is a cause
of stress for social parents, and that this stress has a negative
impact on familial wellbeing (Landau 1998). A potentially more
significant source of family tension is accidental disclosure,
especially when donor-conceived children are older. In this latter
case, several harms might arise, and may be greatly exacerbated if
children were not aware that they were donor-conceived. Children might
develop feelings of distrust towards their social parents, and may
have difficulty incorporating facts about their genetic history into
their personal identity (Turner & Coyle 2000).



While harms caused by both secrecy and accidental disclosure can be
mitigated to some extent without making identifiable information
available, by simply disclosing to children at a young age that they
are donor-conceived for example, some argue that more openness is
better for familial unity, and that providing children with an
opportunity to find out the identity of their donors (even if that is
delayed until they are older) is usually best (Nuffield Council on
Bioethics 2009).



Those who favour permitting anonymous gamete donation argue that, at
best, the evidence suggests a slight improvement in familial wellbeing
when information about a donor is provided along with disclosure about
the method of their conception. Families in which children do not have
access to identifying information about their donors still report good
home-life and have positive relationships with their parents
(Melo-Martin 2014). Thus, while non-disclosure might not be
optimal, it is probably not so harmful that it falls outside of the
domain of parental discretion. Furthermore, if the harms are socially
constructed, as some have argued is the case in genealogical
bewilderment, then we may have additional reasons for concluding that
the harms to family cohesion do not justify prohibiting anonymous
donation, since doing so would only further contribute to biologism
(Melo-Martin 2014).


### 2.4 Fundamental Rights



The arguments against donor anonymity considered thus far focus on
harms that might arise as a result of the practice. Another kind of
argument is that individuals have a fundamental right to knowledge
about their origins. In the legal literature, some have argued that
the UN's Declaration on The Rights of The Child and the European
Convention on Human Rights establishes individuals' rights to
information about the circumstances of their conception, including
information about their progenitors (Blyth & Farrand 2004). Apart
from appeals to such declarations of rights, some attempts have been
made to motivate recognition of a fundamental right to know via appeal
to other fundamental goods.



One strategy is to tie the right to know to the right to an identity.
Here the argument is that individuals require genuine facts about
their biological history in order to develop a proper personal
identity (Ravitsky 2010). However, one response is that while
children have a right to an identity, they do not have a right to a
*particular kind* of identity, such as one based primarily on
historical biological ties (Allen 1996). Another route is to argue
that children have a right to be respected, and that hiding facts
about their origins is a form of deception that we ought not permit
(Freeman 1996). However, deception about origins is only a severe form
of disrespect if we think that biological ties are important in the
first place, and thus this argument risks begging the question.


### 2.5 Policy Argument from Analogy to Adoption



Offspring's ability to access adoption records have oscillated
quite substantially over the past century and a half, even within the
same jurisdiction (Samuels 2000). More recently, regulatory structures
have shifted in favour of providing adoptees with a legal right to
access identifying information about their progenitors (Besson 2007,
Hildebrand 1999). In such jurisdictions, some have argued that,
because gamete donation is sufficiently similar to adoption,
regulatory consistency demands that anonymous gamete donation be
prohibited as well (*Pratten v. British Columbia (Attorney
General)* 2012 BCCA 480; Chisholm 2012; Cahn 2009c - see
Other Internet Resources). While this parity argument only goes so far
in the absence of philosophical justification for prohibiting
anonymous adoption (mere consistency could conversely be achieved by
permitting anonymous adoption) it does give pause to examine the
relevant similarities between the two practices.



The core of the parity argument is that in both adoption and gamete
donation, children are reared by individuals other than their genetic
progenitors. If we think that access to information about genetic
progenitors is important enough to be elevated to the status of a
right in adoption, then we ought to extend the same right to
donor-conceived individuals as well.



In response, Leighton has argues that there are important disanalogies
between adoption and gamete donation such that there may be no
inconsistency in prohibiting anonymity in one case but not the other
(Leighton 2014). For instance, adoptees are generally relinquished by
their initial parent(s), and are often not raised by either of their
genetic parents. In the case of gamete donation there is no similar
relinquishing of parenthood, and often one of the genetic parents is
also a social parent. These differences may very well result in
divergences in the experiences of adoptees and donor-conceived
individuals. For instance, adoptees might feel abandoned by their
initial parents, and be curious about why they were relinquished,
something that is unlikely to be the case in gamete donation.
Furthermore, Leighton argues that since adoption has a history of
stigmatization in the West while gamete donation has no such history,
there is good reason to think that the psychological impact of
anonymous adoption on adoptees will be different from the
psychological impact of anonymous gamete donation on donor-conceived
individuals (Leighton 2014).



While simply demonstrating that there are relevant disanalogies
between adoption and gamete donation does not show that anonymity is
permissible in the latter case but not the former, it does show that
it is not outright inconsistent to have different policies governing
anonymity for each.


## 3. Donor Matching and Selection



Recipients of donated gametes often wish to have some say in what
their donor is 'like'. The characteristics made available
to inform donor selection decisions differ greatly dependent on both
the countries and clinics in which such choices are made. However,
such information tends to include medical, morphological, and
biographical information similar to that found on dating websites,
such as hair colour, eye colour, ethnicity, educational attainment,
job type, hobbies, and religion.



Few commentators suggest that recipient-parents should be barred
completely from accessing information about prospective donors, but
neither is it generally assumed that they should be afforded
unfettered liberty to choose their donors' characteristics.
Thus, the debate in this area tends to focus on where the line between
morally acceptable and unacceptable selection practices lies.


### 3.1 Motivations Underlying Donor Selection



Three main categories of motivation underlie donor selection
decisions.



The first is selection against donors posing a threat to the physical
wellbeing of pregnant women. This form of selection is ubiquitous such
that the barring of donors with sexually transmissible diseases such
as HIV, hepatitis B and syphilis is mandated by national and
international guidelines on gamete donation (see, for example HFE Act
2008: s. T52 - see Other Internet Resources). This motivation
for selection is widely seen as morally unproblematic and will, for
this reason, be largely ignored here.



The second and third categories of motivation, termed here, selection
for 'matching' and selection for 'design' are,
unlike the first, based on parental and/or societal preferences or
values. In practice, most donor selection decisions will fall into
both categories, but a theoretical distinction is nonetheless made
between the two in the philosophical literature.



Selection for 'matching' is performed with the aim of
creating a child who bears a similarity to the recipient parents.
Thus, gamete donors are selected (or deselected) by reference to the
extent to which their physical (and sometimes social and
psychological) characteristics match those of recipient parents
(Quiroga, 2017). As Braverman and Frith (2014) note, the aim of this
practice is often:



> 
> 
> to enable secrecy and concealment of gamete donation. This practice
> incorporates a popular knowledge of genetics and enables the child to
> 'pass' as a naturally conceived child. This is an attempt
> to avoid overt 'difference' between child and couple and
> when a good match is achieved the donor disappears from view.
> (Braverman & Frith 2014: 135)
> 
> 
> 



There may however, be aims other than secrecy and concealment. These
may have their basis in concerns regarding compatibility (wanting our
children to be 'like us' and to 'fit in')
(Ruddick 2000; Wong 2017), premised on physical or psychological
desire (we often choose our reproductive partners because they possess
characteristics that please us), or even with the aim of avoiding
offence - a member of a couple may be offended if his/her partner
prefers a donor with characteristics markedly different from his/her
own (Pennings 2000). Importantly, matching motivations are
distinguished from other motivations for selection as they are limited
only to desires to select for donors with characteristics possessed by
one/both intended social parents and should be based only in a desire
to attain resemblance between parent and child.



Selection motivated by design, however, is performed with the aim of
creating a child with characteristics which may or may not be
possessed by the recipient parents but which are, nonetheless, deemed
by them (and/or society) to be desirable (and often advantageous).
Such selection may thus be performed with several aims in mind. These
include but are not limited to desires to increase the life prospects
of one's children by preventing the birth of children with
disadvantageous or without advantageous characteristics, to satisfy
preferences for a particular 'kind of child', or with the
eugenic aim of improving the gene pool through the selection of donors
deemed to possess 'superior' heritable traits.



Of these two categories, a desire for *matching* is generally
thought to be less morally problematic than a desire for
*design*, since desires for familial resemblance, secrecy
(within limits), and to avoid offence are often considered relatively
benign. This is not, however, to say that no critical work has been
done on this topic as shall be seen in
 subsection 3.3
 which looks to the question of whether race-based matching and
selection practices are morally permissible.



Design-based motivations for selection, however, have been the subject
of a great deal more debate. This discussion largely mirrors (or is
subsumed by) many of the discussions had regarding the ethics of
selective reproductive technologies, such as pre-implantation and
pre-natal genetic diagnosis, and such topics as sex selection and
human enhancement (see the entries on
 pregnancy, birth & medicine,
 and
 eugenics).
 For, although in the context of gamete donor selection there are no
embryos or fetuses involved, nor genetic manipulation performed, there
has been much focus on questions of:


* Whether it might be obligatory for recipient parents and/or
clinics to select against 'disadvantageous' genetic
characteristics in their future offspring via donor selection.
* Whether selection for/against certain characteristics may be
impermissible on grounds that it explicitly or implicitly expresses
misinformed or 'ugly' and discriminatory attitudes towards
existing persons with 'deselected' characteristics.
* Whether the desire to influence children's genetic
constitutions through gamete donor selection represents troubling
parental attitudes which may be contrary to common conceptions of the
good parent and parental virtues such as 'unconditional
love' and 'openness to the unbidden'



With this in mind, throughout the following subsections such debates
will be explored in turn.


### 3.2 Selection against Disability and Disadvantage



The desire to have a child free from disability and disease is often
considered the least contentious ground for gamete donor selection.
Parents and prospective parents, after-all, tend to want the best for
their children and diseases and disabilities can make the attainment
of a 'good life' harder. Given this, and the fact
that donor selection, unlike other forms of selective reproduction,
raises few thorny questions regarding women's rights over their
own bodies and the moral permissibility of abortion or the destruction
of embryos, the dominant position among philosophers regarding gamete
selection for the purpose of disability avoidance is one of
permissiveness (see for example: Robertson 1994; Glover *et al*.
1989; Glover 2006; Strong 1997; Bennett 2001; Wilkinson 2010).
Robertson (1994) sums up this view well when he states:



> 
> 
> The desire not to have a child with serious defects is not itself
> immoral, and actions to avoid such a reproductive outcome should be
> respected as an important aspect of procreative liberty. The question
> then is what means to achieve that goal are acceptable ...
> Preconception selection by voluntary selection of mates or gametes
> raises the fewest problems ... Concern with the genetic fitness of
> a mate may not be romantic but it is rational if one is concerned
> about the health of spouse and offspring. Mate selection should thus
> be left to the individual. Similarly, the selection of a gamete donor
> should be left to the couple that needs this service. (Roberson 1994:
> 154)
> 
> 
> 



Some go further, arguing that donor selection for the purpose of
disability-avoidance is not merely permissible but, in certain
circumstances, obligatory (see, for example: Savulescu 2001; Savulescu
& Kahane 2009; Harris 1985, 2002; Buchanan et al 2000; Glover
1989; Glover 2006). Discussions regarding this matter have tended to
focus less on gamete donor selection and more on the selection of
embryos and fetuses through pre-implantation and pre-natal genetic
diagnosis. However, as Holm and Bennett (2014) and Williams (2017)
note, arguments suggesting a moral obligation to select against
disability in these contexts apply to gamete donor selection too.



Indeed, that this is the case can be seen clearly in the negative
media reaction and public outrage directed towards a deaf couple who,
after deliberately conceiving a deaf child in the early 2000s via the
use of a 5th generation deaf sperm donor, were vilified by
the tabloid media and condemned by the US National Association of the
Deaf. (For interesting and insightful commentaries on this case see
Savulescu 2002; Spriggs 2002; Fahmy 2011.) It can also be seen in the
fact that many countries *require* that clinics screen out
potential donors for heritable diseases prior to their inclusion on
the donor register. A notable example of this is the UK's Human
Fertilisation and Embryology Act which, since 2008, has included a
clause prohibiting the selection of gamete donors and embryos



> 
> 
> that are known to have a gene, chromosome, or mitochondrion
> abnormality involving a significant risk that a person with the
> abnormality will have or develop: (a) a serious physical or mental
> disability, (b) a serious illness, or (c) another serious medical
> condition. (HFE Act 2008, s. 14(4)(9) - see Other Internet
> Resources)
> 
> 
> 



Yet on what grounds might such an obligation be based? Some suggest
that *a moral basis for such an obligation may be found by focusing
on the interests of and/or the rights of the children that will result
from our procreative decisions* (see Davis 2001 for a
rights-focused approach). Arguments falling into this category thus
focus on person-affecting reasons, picking out the harms or limits to
opportunity associated with certain disabilities as providing good
reason to select against donors with traits liable to result in such
harms and limits to opportunity. Such an approach is intuitive.
However, given the conclusions of the Non-Identity Problem (see the entry
on
 the non-identity problem),
 many question the logic of appeals to the interests of the child
created in all but cases of the most severe disabilities. For, as it
is generally held that a life with a disease or disability is better
than no life at all, and selection decisions alter who it is that
comes to exist rather than the prospects of determinate future
persons, a focus on the interests of future children cannot ground
such an obligation (Bennett 2009; Parfit 1984; Parker 2007; Robertson
1994).



Others suggest that although the objects of our procreative efforts
may not be harmed by being born with a disability, prospective parents
may nevertheless have good moral reason to select against disability
in their offspring on the basis of other considerations. These include
appeals to the interests of others whose interests may be affected by
our reproductive decisions such as existing children and other
dependents (Roberts 2009) and taxpayers in countries with socialized
medical and welfare systems (Heyd 1995; Fahmy 2011; Rakowski 2002;
Williams 2017); appeals to the claim that to fail to take reasonable
steps to prevent disability in one's future children is contrary
to common conceptions of the good parent (Steinbock & McClamrock
1994); and to the suggestion that that those who fail to avoid
disability in their offspring act wrongly as they deliberately or
negligently choose to create a state of affairs that is strictly worse
(in terms of some particular value such as happiness/preference
satisfaction) than the state of affairs that could have been created
had they chosen differently (Harris 1985; Parfit 1984; Glover 1989;
Glover 2006). (See the entry on
 eugenics
 for a more detailed treatment and criticisms of different arguments
in support of an obligation to select against disability.)



Such arguments have, however, been criticized on a number of grounds.
Some suggest that parental obligations to their offspring cannot be so
strong as to ground an obligation to select against disability
(Williams 2017); others claim that "complex concepts such as the good
life, the best life, and human flourishing, are not reducible to
simple elements or constituent parts which might be identified by the
testing of embryos [and selection of sperm donors]" (Parker 2007:
281); and others still question the link between disability and low
levels of welfare (Barker & Wilson, 2019) and/or claim that
appealing to impersonal harms devalues those with disabilities by
suggesting that their lives are worth less than those without
disabilities (Asch 2003; Bennett 2009). Yet, while many authors
suggest that there cannot be an obligation to select against
disability, it is often held that prospective parents should still be
at liberty to select against disability in their offspring on the
basis of personal preferences.



Among a number of authors associated with the disability rights
movement however, a different claim is made. For, such authors suggest
that not only can there be no moral obligation to select against
disability, parental preferences to screen out disabled donors are
morally problematic for two reasons. The first regards the messages
that such preferences send about and towards persons living with
disabilities, ones which may be seen as discriminatory and offensive:
"express[ing] a hurtful attitude about and a hurtful message to
people who live with [disabilities]" (Parens & Asch 1999:
S2). The second is that the desire to select against disabling genetic
traits is based on misinformation regarding both the severity and true
nature of disability. In terms of severity, for example, it has been
widely reported that persons with disabilities tend to report good
quality of life despite the fact that most (non-disabled) observers
suggest the opposite (for work on the disability paradox see Albrecht
& Devlieger 1999). Regarding the true nature of disability, it is
claimed that contrary to the views of many, who hold that disability
is inherently disadvantageous, many (and, for those who take an
extreme approach, all) of the harms associated with disability are
socially constructed. That is, they are often not the result of
failures in functioning but society's failing to account for
everyone when designing physical, economic, and social institutions
(Glackin 2010). Thus, it is suggested that as disability is often not
a feature intrinsic to those who suffer it, to attempt to prevent
disability by preventing the existence of persons with disabilities is
very much akin to attempts to prevent sexism or racism by preventing
the births of black people and women: an inappropriate response to a
social problem (Asch 2003).



Taken to extremes, however, social constructivism is often viewed as
irredeemably flawed by the academic community and a great number of
able bodied and disabled persons alike. Robert Kitcher expresses this
well when he notes that if we take a wholly social constructivist
view



> 
> 
> attempts to decrease the incidence of Tay-Sachs will be no different
> from Northern Indian sex selection or from anticipated future efforts
> to cure lesbians. (Kitcher 1996: 215)
> 
> 
> 



(See the entries on
 parenthood and procreation
 &
 eugenics
 for more in depth discussion of the suggestion that there may be a
moral obligation to select against disability in our offspring and the
entry
 disability: definitions, models, experience
 for more information on models of disability.)


### 3.3 Characteristics Related to 'Race'



Questions and concerns have also been raised regarding the
appropriateness of selection on the basis of characteristics related
to 'race', such as skin, eye, and hair colour. Had gamete
donor selection been well known in the 1980s when discussion raged
concerning whether trans-racial adoption practices constituted a step
in the right direction towards the social ideal of colour-blindness, a
form of racial and cultural genocide, or something in between the two,
one might have expected to see similar discussions regarding donor
selection. This, however, has not been the case and instead, the
philosophical literature on race-based selection has tended to focus
on the question of whether selection of race-based characteristics is
appropriate at all.



For the most part, this focus is due to contemporary debates regarding
the question of whether the concept of race is philosophically and
scientifically defensible. Thus, work suggesting the removal of racial
identifiers on donor catalogues seems to owe a great deal to authors
such as K. Anthony Appiah (1995, 1996) and Naomi Zack (1993, 2002) who
both deny that race is a coherent concept and recommend discarding it
entirely (see the entry on
 race).



Fogg-Davis (2001), for example, suggests that both the practice of
reproducing race through assisted reproduction and selecting donors on
the basis of different race-linked characteristics are problematic as
they raise two major linked ethical issues:



> 
> 
> one is the harm that racial stereotyping causes to individuals, and
> the second is the public awareness that racial stereotyping is an
> accepted feature of this largely unregulated market.
> 
> 
> 



She suggests that those who use racial classification to inform donor
selection decisions are communicating that



> 
> 
> race is heritable and relevant to their vision of family
> structure ... that a person's gametes are transmitters of
> racial meaning that can and should be selectively transmitted to their
> child through the use of reproductive technologies. (Fogg-Davis 2001:
> 18)
> 
> 
> 



Harris (1998) too questions the legitimacy of the desire to match
donors to recipient parents on the basis of race-linked
characteristics such as skin tone, and hair and eye colour. He
notes:



> 
> 
> Why do so many people firmly believe that children should be like
> their parents, particularly in terms of their general colour and
> racial characteristics? It is difficult not to view this desire, and
> attempts to implement it, as a form of 'ethnic cleansing.'
> It smacks very much of the pressure that so many societies and
> cultures have put upon their members not to 'marry out' or
> to put it more bluntly, not to mate with somebody of another tribe or
> race. (Harris 1998: 21)
> 
> 
> 



Others suggest, however, that there is "no evidence to suggest that
racial prejudice accounts for why sperm banks sort sperm donors
according to race or why many prospective parents hope for a child of
a particular race." (Fox 2009: 1860) Such authors hold instead that
racial preferences in gamete donation are more likely to stem from a
desire to replicate the family structure of the biological family, to
avoid deficient access to racial culture and consciousness (Maung
2019:114), to increase their children's prospects in unjust
social contexts (Savulescu & Kahane 2009), or premised on a desire
"to make the donor invisible and to conform the new-founded
family to the ideal of the natural family" (Pennings 2000: 508).
As Wong (2017) notes: "recipient parents who choose not to prioritise
matching ... may embark on a project of queering heteronormative family
structures and place great trust in both their own children and
changing social attitudes to reduce stigma and generate acceptance for
non-traditional families." (Wong 2017:77).



Given such considerations, it has been argued that although race-based
selection should not be condemned in all cases it is important to
"soften the prominence of race in donor selection by taking
measures to frustrate wholesale filtering of sperm donors on the basis
of race" (Fox 2009: 1893). Others still note that those who
desire to select for race-linked characteristics for these 'less
objectionable' reasons must still consider the wider
consequences of doing so. Maung (2019), for example, suggests that
while a desire to respect the rights of marginalised communities to
maintain their ethnic identities, and to ensure that donor conceived
children from historically subjugated ethnic groups develop a positive
ethnic identity, and reap the benefits of belonging to a community
with a rich shared history, such concerns should be "counterbalanced
by the concern about capitulating to the racialist assumptions that
enabled that subjugation in the first place" (Maung 2019:115).
Berkowitz & Snyder (1998), Agar (2004) and Marway (2018) make
similar points when considering the question of race-based selection
of offspring. They suggest that while the aim of increasing the life
prospects of one's children in racist and homophobic societies
by selecting for heterosexual and light skinned offspring is not
objectionable, such practices should not be permitted. For, not only
would such selection collude with prejudice, constituting an
inappropriate response to a social problem, but it would likely also
undermine attempts to change racist and homophobic social attitudes
and practices.


### 3.4 Parental Virtues, Expectations, and Openness to the Unbidden



Gamete donor selection may also be motivated by a desire to parent a
'particular kind of child' such as where a music lover
seeks out a concert pianist in order to increase the likelihood that
the future child will possess such talents, or where a couple seek out
gamete donors with genius level IQ in order to increase the likelihood
of rearing an academically gifted child (as with the couples who
purchased sperm in the 1990s from the 'repository of germinal
choice') (Plotz 2006) .



Such cases raise a different kind of concern about whether selection,
when performed in order to satisfy these kinds of preferences,
encourages and facilitates the development of ethically troubling
attitudes on the part of prospective parents.



This concern has been expressed in various different ways. Some, for
example, suggest that selection motivated by such desires is
incompatible with parental virtues such as 'acceptingness'
(McDougall 2007), 'openness to the unbidden' (Sandel
2007), and 'unconditional love' (Herrisone-Kelly 2007).
Those who take this view hold onto the traditional notion of the child
as a gift and correspondingly suggest that parents ought to care, not
about the traits that their children possess, but about developing a
loving relationship with and raising whatever child they receive.
Others take a more Kantian line, suggesting that such parents
are wrongfully instrumentalising their children: treating them as a
means of fulfilling parental hopes and dreams rather than as entities
who, once born, exist for their own sake (Davis 1997).



Yet the suggestion that a selective mentality is incompatible with
important parental virtues or problematically instrumentalises
one's future children has been the subject of some debate.
Authors such as Ruddick (2000) and Green (2008), challenge the
'maternalist assumption' that parents



> 
> 
> who want a child should accept and welcome any child they happen to
> receive, prepared to appreciate the child's developing
> individuality, however different from their own. (Ruddick 2000:
> 102)
> 
> 
> 



They hold instead that other conceptions of parenthood can, provided
they are not taken to extremes, be perfectly adaptive, and crucially,
do not require parents to refrain from all attempts to shape the
characteristics of their prospective children. They suggest that
parents should rightly be viewed as both guardians of the
children's future interests, and 'gardeners' who may
shape and raise children in line with their own preferences and
priorities.



Others question whether the virtues of the prospective parent are the
same as those of an existing parent. For, although some hold that a
desire to have a hand in the characteristics of one's future
children is part of a broader desire to parent and thus requires
"committing oneself to acting and evaluating one's actions
and decisions in light of the project of parenthood" (Vehmas
2001: 439), others argue that a desire to select is not incompatible
with such a commitment. Kamm argues, for example, that a distinction
can be made between 'caring to have' a particular child
and 'caring about' one's future children once born
and suggests that there is little reason to assume that the desire to
seek out certain attributes in one's children is incompatible
with parental virtues or common conceptions of the good parent. She
notes



> 
> 
> one can know that one will care about someone just as much whether or
> not she has certain traits and yet care to have someone that has,
> rather than lacks such traits. (Kamm 2009: 113)
> 
> 
> 



This is echoed by Wilkinson who, discussing a hypothetical example of
two prospective parents who seek to ensure the birth of a blue eyed
child and agree that they will put it up for adoption after birth
should it not possess such characteristics, notes



> 
> 
> it is not the desire to select that violates the principle of
> unconditional love [or other parental virtues], but rather the plan to
> reject the child if it does not live up to expectations ... it is
> entirely possible to want to select characteristics while not having
> this problematic attitude of rejection. (Wilkinson 2010: 29)
> 
> 
> 



Some suggest, however, that although selection is not necessarily
morally problematic, we should still be concerned that a selective
mentality may be a precursor of conditional, as opposed to
unconditional, love once the child is born, or to unrealistic
expectations and feelings of entitlement. Thus, the suggestion here is
that people who go to great lengths and incur great expense in
procuring what are, for them, the 'perfect' gametes, may
be more likely to reject or otherwise mistreat their children should
they fail to develop the 'right' capacities and interests
(see, for example: Kass 2003; Sandel 2007). Again, however, it is not
at all clear that the link between a selective mentality in
reproduction and overzealous and unforgiving parenting styles is a
necessary one, as the majority of parents are not liable to be so
naive as to "presume to know what they are getting simply
because they had a hand in selecting some of their child's
genetic features" (Fahmy 2011: 7), or indeed that gamete donor
selection is *as likely* as other *more expensive* and
*effective* forms of selective reproduction (such as genetic
engineering) to produce such problematic expectations and
attitudes.


## 4. Payment



Should gamete providers be paid? If so, should such payments be
limited to compensation (possibly including compensation for time and
inconvenience)? Or is incentivising or rewarding providers also
morally acceptable?



In favour of payment, the main reason cited is increased supply, thus
enabling recipients to have children that they wouldn't
otherwise have had--or, where scarcity *per se* is not an
issue, giving recipients more choice. In addition, supporters of
payment cite justice (gamete providers deserve to be rewarded) and
autonomy (providers and recipients should be allowed to contract with
each other as they see fit). Finally, pragmatic arguments are
sometimes offered, such as the cost of prohibition or the possibility
of its leading to an unregulated 'black' or
'grey' market in gametes. (Resnick 2001; Steinbock 2004;
Wilkinson 2013)


### 4.1 Familiar Arguments from Other Contexts



Some of the arguments and issues concerning payment for gametes
closely resemble ones arising in other areas such as organ sales, sex
work, and commercial surrogacy (see the entries on
 exploitation,
 feminist perspectives on reproduction and the family,
 feminist perspectives on sex markets,
 parenthood and procreation, and
 the sale of human organs).
 We deal with these briefly here before moving on to consider in
greater detail some of the more distinctive issues raised by paying
gamete providers. The focus here is on gametes for clinical use in
human reproduction, rather than gametes for research purposes,
although many of the same issues also arise in a research setting.


#### 4.1.1. Harm and/or Risk to Donors



One of the most obvious issues is harm or risk to the providers
(Resnick 2001; Steinbock 2004).



In the case of sperm, the physical risks of donating are negligible,
but concerns have been raised about psychosocial risks, especially if
one man is permitted to generate numerous offspring. What happens, for
example, if a single sperm donor produces hundreds of children and a
significant proportion of those contact him years later? That could
have a significant impact on the man's life (and on the welfare
of the children, discussed below). One way of containing this risk
would be to limit donor offspring numbers; another would be to allow
donor anonymity, although that may be objectionable on other grounds
(see our earlier discussions of donor anonymity and donor offspring
limits).



Producing hundreds of children is unlikely to be a problem for egg
donors but, unlike sperm donors, these women do face non-negligible
physical risks: notably OHSS (Ovarian Hyper Stimulation Syndrome).



As with the organ sale debate, though, it is not clear why the
existence of these risks constitutes an objection to *payment*,
as opposed to an objection to *the whole practice of gamete
donation* (paid or otherwise) since the risks don't increase
as a result of payment (Wilkinson 2013). In response to this, in the
case of sperm donation, it could be argued that the scenario where one
man produces hundreds of children is much more likely to happen if
payment is allowed, as some men seek to become 'professional
sperm donors'. As has been noted, however, it should be possible
to neutralise this risk by enforcing donor offspring limits.


#### 4.1.2. Consent, Exploitation, and Inducements



Another set of issues is the negative effect that payments, or
payments above a certain level, are supposed to have on the quality of
consent--a concern that is closely linked to worries about
exploitation. Financial incentives, it is argued, encourage people to
do things that they would not otherwise do, encourage them to do
things that are harmful, and make their actions, consents, and
decisions less likely to be autonomous and voluntary (Resnick 2001;
Steinbock 2004; Wilkinson 2013). These arguments are more often
directed at paid egg donation than paid sperm donation, because the
direct physical risks and the sums of money involved for eggs tend to
be much greater. Thus, people have been concerned that vulnerable
young egg donors might be lured into the egg market and then exploited
by clinics, egg banks, or recipients. These concerns structurally
parallel ones that people often have about commercial surrogacy and
sex work.



Arguments of this kind are dealt with in much more detail in the
entries on
 Exploitation,
 Feminist Perspectives on Sex Markets,
 Parenthood and Procreation,
 Informed Consent, and
 The Sale of Human Organs.
 For the present, we simply note that, while the possibility of
defective consent and exploitation must be taken seriously in any
system of paid gamete donation, there seems no reason in principle why
paying for gametes must be exploitative, nor why it cannot be validly
consented to. Provided that the payment-levels are fair, and that the
provider's situation, mental capacities, and access to
information are all sufficiently favourable, it is hard to see
why--in common with other financial transactions--gamete
provision can't be validly consensual and non-exploitative.


#### 4.1.3. Commercialisation and Selection



Finally, we note here that there is a connection between remuneration
arrangements and selection practices (discussed above). In particular,
one objection to allowing payment--or at least to the unfettered
commercialisation of gametes--is that it may encourage a market
in which particular traits can, for those willing to pay a high price,
be aggressively selected for. For example, in the USA, young
attractive white female egg donors attending 'Ivy League'
universities can command a higher fee for their eggs than other
donors--and anyone who is willing to pay can have access to those
eggs. So, anyone who regards selection practices like this as
problematic may also regard the commercialisation of gametes as
problematic inasmuch as it underpins and enables fine-grained
selection by 'gamete consumers' to take place.


### 4.2 Payment and the Welfare of the Child



We turn now to some of the more 'distinctive' issues
relating to paying gamete donors. The first of these is the welfare of
the child created. While this issue is 'distinctive'
inasmuch as it applies only in the reproductive sphere (and so not to,
for example, organ sale) it does arise in other reproductive areas,
notably commercial surrogacy (Harris 2000).



The main worry here is that when donor-conceived children find out
that money is what primarily motivated the donor then, in some cases,
this will have adverse psychological effects; in the most extreme case,
they may come to feel that they were 'bought' (HFEA 2011).
What follows from this possibility, however, is unclear.



To start with, there are empirical questions about how many
donor-conceived people will feel this way and about how severe their
negative feelings (if any) are. Not all donor-conceived people have
negative feelings about donor motives and financial reward; some may
not care what their donors' motives were. So, if this concern is
going to ground an ethical argument against paying donors, a solid
evidence base will be needed to underpin its empirical premises.



Similarly, there is a set of questions not so much about what donors'
*actual* motives are, but about what they write on their
donation papers, and about how and when information is conveyed to
their offspring. One view is that, for the sake of the welfare of the
child, it would be better for donors to 'tell a story'
(even if not wholly accurate) that donor-conceived children will find
more palatable than the bare truth that the donor simply needed money.
Another is that if donor-conceived children are communicated with
appropriately, honestly, and sensitively, and at an early stage then
any problems associated with donor motives will be minimal (Nuffield
Council on Bioethics 2013).



Still, let's allow (at least for the sake of argument) that
these problems are insurmountable: that--whatever we do--a
significant number of donor-conceived children will be substantially
harmed by the knowledge that their donors were paid. What follows from
this?



First, we should note that this area is subject to the implications of
the Non-Identity Problem (Parfit 1984). In particular, given that
(let's assume) many paid sperm donors *would not have donated
but for the money*, it is plausible to supposed that children who
suffer psychological harm when they find out about their donors
*would not have existed if there hadn't been payments*.
Therefore, for standard reasons relating to the Non-identity Problem,
they may not be *harmed* by the practice of payment--or at
least not in the usual comparative harm-to-interests sense (worse off
than they would otherwise have been). (See the entry on the
 non-identity problem.)
 So, while there may still be a child welfare argument against
payment, it must rely not on harm-avoidance but rather on impersonal
welfare considerations.



Given this, a lot hinges on whether payment is required to ensure an
adequate supply of donor gametes. If it is not (if, for example, the
reasons for paying people are quite trivial ones, such as
administrative convenience, or even allowing recipients more choice)
then the fact that payment will adversely affect the welfare of donor-conceived children does
looks like a good (albeit *prima facie*) reason to prefer
altruistic donation. Imagine that we have a choice between creating a
population of donor-conceived children using paid donors or a
different but equally large population using altruistic donors. If (as
we're allowing) the latter will have a higher quality of life
then there is a strong 'impersonal' reason, other things
being equal, to prefer the latter: altruistic donation. Things look
rather different though if the choice is instead between a population
of donor-conceived children using paid donors or a different *and
significantly smaller* population, for then it would be necessary
to 'trade off' a higher average quality of life against
both (a) the fact that there are fewer lives overall and (b) any harm
done to prospective parents who are denied the opportunity to raise a
donor-conceived child. Any such moral calculation will be complex and
this goes to show that, in cases where payment is required to secure
an adequate supply of gametes, this is not obviously wrong (all things
considered) even if there are detrimental effects on donor-conceived
people's quality of life (Wilkinson 2016).


### 4.3 Egg Sharing



Some countries (notably the United Kingdom) either prohibit or
strictly limit payments to egg donors but allow an exception whereby
'egg sharers' (women who are themselves undergoing
infertility treatment and wish to donate in return for reduced fees)
can receive unlimited benefits-in-kind in the form of cut-price
infertility treatment services. The UK, for example, limits payments
to egg donors to PS750 (approx. US$900) and yet egg sharers can
have their own treatment costs reduced by many thousands of pounds
(HFEA 2017: guidance note 13).



This raises the question of whether *ethically* egg sharing is
preferable to egg selling and, if so, why--along with the closely
related question of whether egg sharing should be treated more
favourably in law and professional regulation (Blyth & Golding
2008).



The main reason offered in favour of egg sharing is that
'sharers' are exposed to less additional harm and/or risk
than donors (paid or otherwise), since they are *already*
undergoing most of the required interventions as part of ongoing
treatment. It is supposed to follow from this that incentivising egg
sharing (other things being equal) is less morally problematic than
incentivising egg donation: either because of the putative wrongness
of encouraging people to take 'excessive' risks, or
because financial incentives may vitiate consent to those risks
(Wilkinson 2013).



This does seem like a sound *prima facie* reason to prefer egg
sharing although several caveats must be noted. First, some special
types of risk may apply to egg sharers: for example, older women who
don't have many viable eggs left might reduce their chances of
having a child by giving away 'surplus' eggs (Scott,
Williams, Ehrich, & Farsides 2012). Second, and similarly,
concerns about consent may apply just as forcefully to egg sharers as
to egg sellers, especially if some of these are
'desperate' to have a child and egg sharing is their only
way of paying for infertility treatment services (Blyth & Golding
2008). Thirdly, as already mentioned, this argument--if it
worked--would show egg sharing to be superior not only to paid
donation but also to altruistic donation, since the additional risks
are the same whether paid or not (Wilkinson 2013).



A different kind of reason for treating egg sharing more favourably
than egg selling is based on the idea that egg sharers' motives
will typically by morally preferable to those of egg sellers. In
particular, it has been claimed that whereas egg sellers are typically
motivated by the desire for money, egg sharers act partly out of a
sense of solidarity with potential recipients--in particular
because both the sharer and the recipient are in similar positions.
Both need, or want, infertility treatment services in order to have a
child (HFEA 2011; Prainsack & Buyx 2011).



However, whether this really justifies the differential treatment of
benefits-in-kind (treatment services) and monetary reward is far from
clear. One reason for doubt is that, as the HFEA notes:



> 
> 
> What is known about donor motivation ... is that it is
> multifaceted. People make decisions for a range of reasons, and
> competent adults are capable of assessing the relative benefits,
> burdens and likely impact of a range of options available to them. An
> incentive to donate does not necessarily mean people will do so purely
> because of that incentive. Indeed, the literature suggests that both
> donors and sharers have mixed motives for donating. (HFEA 2011:
> section 2, 4.4 [p. 8])
> 
> 
> 



This suggests that, in relation to solidarity, there is no categorical
difference between payment and benefits-in-kind. While some egg
sharers may be motivated mainly by feelings of solidarity, others may
be more interested simply in saving money. Conversely, while some paid
donors would be 'in it just for the money', others
(perhaps those whose close friends or relatives have fertility
problems, or who have experienced health problems of their own) could
be moved to donate because of feelings of solidarity (the fact that
they are financially rewarded notwithstanding). As such, it is by no
means obvious that all egg sharers are motivated by feelings of
solidarity, or that all paid donors would fail to have this feeling.
Indeed, it is by no means obvious even that *most* egg sharers
are motivated by feelings of solidarity and there is empirical
evidence suggesting that the number of sharers significantly decreases
when state funded treatment is made widely available (Pennings
2009).



Finally, and more fundamentally, *even if* donations motivated
by altruism or solidarity were morally preferable to more
self-interested ones (donations motivated purely by the desire for
money, for example) it would not necessarily follow that the latter
are wrong or should be prohibited. For, it may just be that the former
are *supererogatory*: that while paid donation is merely
permissible, unpaid donation is an act of generosity or solidarity that
goes beyond what is morally permitted or required (Wilkinson &
Garrard 1996).