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Ovum donation: examining the new Israeli law
European Journal of Obstetrics & Gynecology and Reproductive Biology 159 (2011) 40–42
Contents lists available at ScienceDirect
European Journal of Obstetrics & Gynecology and Reproductive Biology journal homepage: www.elsevier.com/locate/ejogrb
Review
Ovum donation: examining the new Israeli law Benjamin F. Gruenbaum a, Zachary S. Pinchover b, Eitan Lunenfeld c, Alan Jotkowitz a,* a
Department of Medicine F, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel The University of Connecticut, Storrs, CT, USA c In-Vitro Fertilization Unit, Division of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 26 January 2011 Received in revised form 7 May 2011 Accepted 11 July 2011
Ovum donation affords countless couples that under natural circumstances would not be able to produce offspring the ability to carry out natural pregnancies. With advancements in biotechnology including egg collection and in vitro fertilization (IVF), physicians can now successfully implant fertilized embryos. Due to Israel’s tremendous involvement in IVF for its own citizens, the national laws that govern egg donation are of great importance. On September 5th 2010, the Israeli Parliament (Knesset) passed a law that allows young women between the ages of 21 and 35 to donate their eggs for paid financial compensation. The new law allows infertile women between the ages of 18 and 54 to request egg donation and IVF, which will partially be covered under state insurance plans. This article provides a description of the new Israeli law regulating ovum donation and the practical, moral and ethical debate surrounding the new system. ß 2011 Elsevier Ireland Ltd. All rights reserved.
Keywords: Egg donation Ethics In vitro fertilization Israel Law Ovum Religion
Contents 1. 2. 3. 4. 5.
Introduction . . . . . . . . . . The new ovum donation Religious concerns . . . . . Ethical considerations . . Future directions . . . . . . References . . . . . . . . . . .
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1. Introduction With advancements in biotechnology including egg collection and in vitro fertilization (IVF), physicians can now successfully implant fertilized embryos allowing otherwise infertile women to carry out natural pregnancies. In this process, potential donors are screened for various infectious and reproductive organs are examined to ensure their health. Ova are collected through a minimally invasive procedure under general anesthetics lasting on average 15 min [1]. Physicians are then able to artificially inseminate the extracted eggs and implant the embryo using IVF. Ovum donation, like other types of organ donation, has the ability to help many couples that under natural circumstances
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would not be able to produce offspring. Reasons of infertility may range from early onset menopause, middle-aged patients, underdeveloped or nonexistent ovaries and predisposition to genetic diseases [2–4]. The laws that govern ovum donation are complex and not uniform. The United States leads the world in the number of egg donations (E.D.) and has the highest rate of children being born through IVF-E.D. [5]. In some European countries including Spain and the UK, egg donation is less regulated while in others such as Germany and Italy it is more restricted [6]. Because the cost and regulation of IVF-E.D., medical tourism industries have become widespread in India, Thailand and other countries [7]. 2. The new ovum donation proposal
* Corresponding author at: Prywess Center for Medical Education, Faculty of Medicine, BGU, POB 151, Beer-Sheva 84105, Israel. Tel.: +972 8 6477415; fax: +972 8 647773. E-mail address: [email protected] (A. Jotkowitz). 0301-2115/$ – see front matter ß 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejogrb.2011.07.011
Due to Israel’s tremendous involvement in IVF both for its own citizens and Israelis’ coming from abroad, the national laws that govern egg donation are of great importance. On September 5th
B.F. Gruenbaum et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 159 (2011) 40–42
2010, the Israeli Parliament (Knesset) passed a law that allows young women between the ages of 21 and 35 to donate their eggs for a value set by the health ministry (Article 43) [8]. The law allows infertile women between the ages of 18 and 54 to request IVF-E.D., which will be partly covered under state insurance plans. This requires that the donor’s identity be kept confidential; however, IVF babies will be able to confirm their status with the court/Interior/Welfare Ministry after the age of 18 in an attempt to prevent interfamilial breeding (Article 36) [8]. The law also increases oversight and regulation on behalf of the government (Article 1) [8] while limiting a woman to a maximum of three donations with a three month interval between each intervention. The extraction of eggs must also be performed in Israel (Article 5) [8]. Before the passage of the law, egg donations were only permitted if the female donor underwent in vitro fertilization treatments that were deemed medically necessary yielding available ova [9]. Donors also had to provide eggs altruistically thereby prohibiting financial compensation despite reducing their chances to conceive due to ovum donation [10,11]. This created a great scarcity of available eggs, as many women were discouraged to donate eggs, forcing many Israeli women to travel abroad in order to obtain eggs from abroad via third party sources usually at tremendous costs. The new law will likely increase the number of Israeli women who desire E.D. treatment given that the availability of ova should increase with the new compensation measures and due to some of the costs being covered by national insurance. 3. Religious concerns Religion is an intrinsic part of the multi-ethnic Israeli culture with large religious populations including Jews, Muslims and Christians among others. The implications of the new law may undermine various religious convictions. The Chief Rabbis of Israel support both IVF and embryo transfer [12,13]. The Jewish perspective towards procreation originally comes from the first commandment in the Jewish Torah (Bible) that Adam received from God to ‘‘Be fruitful and multiply’’ (Genesis, 1:18). Thus, as long as no prohibition is violated, any method of procreation, including IVF and embryo transfer, may be used to produce a pregnancy [14]. Nevertheless, many Jewish authorities express concerns over the unclear religious status of children born via IVF-E.D., especially from non-Jewish egg donors. Orthodox Jewish law states that only offspring of a Jewish mother is considered to be born a Jew (Ezra 10:3). However, in regards to oocyte donation, there is a debate as to whether the oocyte donor or the women who physically gave birth to the child should be regarded as the mother [13]. For this reason, many rabbis suggest that any child born from an ova collected from a non Jewish mother should undergo a formal religious conversion once born. While the identity of the donor is kept anonymous, the Israeli law states that the religion of the donor is to be made known to the future parents in order to alleviate such problems. Furthermore, according to some opinions of Jewish law, the oocyte donor must be an unmarried woman, in order to prevent the possibility of the act to be considered a form of adultery [13]. Despite these concerns, assisted reproduction is generally an accepted practice, even among the orthodox. In fact, the first reported birth following ovum donation was of a religious Jewish patient and was performed under the permission of the Chief Rabbi of Israel [13,15]. While the collecting or wasting of sperm is generally forbidden in Judaism, these practices are ultimately allowed for the purpose of IVF [14]. Islam, the second most popular religion in Israel generally encourages IVF as a means to procreation, a duty that Islam regards highly [12,16,17]. However, it is preferred that IVF use gametes
41
from the parents that are trying to conceive. Therefore, oocyte donation is generally prohibited in Islam, since the two parties involved are not husband and wife and thus the act may be considered infidelity [3]. However, there exists the possibility of using eggs from a second wife and some Islam clerics have suggested this as a permitted option. The new Israeli law for ovum donation establishes a committee that can approve requests to allow individuals to designate a relative to receive their egg donation, given that there are religious reasons justifying such a donation (Article 22) [8]. The Catholic Church prohibits the donation of eggs either altruistically or for payment [12]. The Church views procreation and sexual intercourse as two inseparable phenomena, which must accompany one another. The Church forbids even the simple IVF where couples extract their own gametes but use IVF to maximize the chances of conception. Further issues revolve around the fact that IVF methodology often includes the production of excess frozen embryos that may never be implanted and are often discarded. The Church considers an out-of-body zygote as a fetus and is entitled to the rights of any human. Therefore any act that tampers or destroys a fetus is considered an act of abortion, and ultimately murder [14]. Similarly, the Church has issues with cryopreservation of such zygotes due to the potential harm and lack of respect the method may cause towards the zygote [14]. Therefore, in the case of egg donation, where a third party is used, ideal procreation in the eyes of the church is not accomplished and therefore forbidden by the church [6]. Thus, while many Christians have more liberal stances on this issue, Christians of the Catholic tradition would not drive benefit from the proposed law. 4. Ethical considerations When examining the ethical implications of widespread egg donation it is crucial to understand how such laws would affect the individual’s autonomy. The concept of autonomy demands that human beings have full control over their bodies and have the ability to make the choices they see fit. It is only possible to give true consent if the individual has autonomy and is making decisions freely. Before the passing of the new law, all egg donations in Israel were theoretically done on an altruistic basis and no financial or other compensation was provided. Donors typically underwent egg donation because they recognized an inherent value in procreation. Due to the lack of financial incentives, those that chose to donate their eggs most likely did so autonomously because they truly desired to help another individual making their consent valid [5]. With the passing of the new law, despite the governmental regulation, the financial incentives could undermine one’s autonomy and ability to make proper decisions. Therefore it is imperative that the compensation levels are high enough to cover the inconveniences and suffering that egg donors must incur during the egg collection process. However, if compensation levels are too high, payment can become coercive and many individuals might come to regret having donated which was a direct result of a difficult financial situation [6]. Such a case would be unethical because autonomy is compromised and proper consent cannot be given. While the exact compensation has yet to be determined, experts will attempt to insure that it will sufficiently compensate without causing unwanted or rash behavior. It is possible to test whether payment levels are appropriate by experimenting with compensation levels and determining how the volunteering egg donation population changes. Ideally egg donors should come from different socioeconomic and cultural backgrounds to ensure that financial compensation is not an overriding imperative [18]. For example if compensation levels only attract those earning in the lower income bracket, the financial compensation may be too influential
42
B.F. Gruenbaum et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 159 (2011) 40–42
and may need adjusting to ensure that those consenting are providing autonomous consent [18]. In the new Israeli context further research is needed on what effect financial compensation has on the socioeconomic makeup of the donors. If donors primarily come from lower socioeconomic classes the ethical principles of justice and social equality might be adversely affected. The major legislative change in the new law is the compensation that will be provided to egg donors; previously all donations were theoretically altruistic in nature. It seems ethical that the egg donors should be compensated for their services. The various researchers, scientists and physicians are all compensated for their services in egg extraction. Therefore it seems unjust that a major contributor to egg donation, the donator, would not be compensated. The new law recognizes this injustice and attempts to correct it by providing compensation to all those involved in the egg extraction process [19]. Yet, others state that financial compensation may lead to a situation where the woman’s body is treated simply as an object to use in the service of others [20,21]. In addition, it is crucial that before giving consent the donating woman is informed of all the potential health risks and adequate attention is given to her healthcare follow-up. The limitation of three donations is partly due to a concern for the woman’s health. Besides the ethical concerns before conception, there are also concerns about children conceived via egg donation and in vitro fertilization. The law will theoretically increase the amount of eggs available and hopefully lower the costs of IVF. This will allow many more couples to take part in infertility treatments allowing them to procreate. As the number of children born via IVF-E.D. continues to grow, it may be important that children are made aware in order to prevent partial inbreeding, which can result in greater risk for various genetic diseases [1]. The law does provide progeny of IVF the right at age 18 to determine their biological status while leaving the egg donor anonymous (Article 36) [8]; perhaps a more effective mechanism needs to be setup to notify these children. However, this needs to be balanced against the desires and needs of the parents which might make a mandatory notification system problematic from their perspective. 5. Future directions The law also has the ability to prevent corruption and illegal behavior that was not uncommon pertaining to egg donation and IVF [22]. Under the auspices of the Israeli ministry of health, egg donation will be closely monitored and controlled. Proper pre-egg donation testing will be administered to ensure that the eggs are free of disease and viruses. Compensation will be regulated for
donors and the costs of IVF will generally be covered for recipients ensuring that many can benefit from IVF treatments not only upper earners. The law seeks to protect the rights of the individual egg donors while providing more citizens with the ability to procreate despite the infertility syndromes they may be experiencing.
References [1] Schenker JG. Ovum donation: ethical and legal aspects. J Assist Reprod Genet 1992;9(October (5)):411–8. [2] Shulman A, Frenkel Y, Dor J, Levran D, Shiff E, Maschiach S. The best donor. Hum Reprod 1999;14(10):2493–6. [3] Isikoglu M, Senol Y, Berkkanoglu M, Ozgur K, Donmez L, Stones-Abbasi A. Public opinion regarding oocyte donation in Turkey: first data from a secular population among the Islamic world. Hum Reprod 2006;21(January (1)):318– 23. [4] Yaron Y, Botchan A, Amit A, Kogosowski A, Yovel I, Lessing JB. Endometrial receptivity: the age-related decline in pregnancy rates and the effect of ovarian function. Fertil Steril 1993;60(August (2)):314–8. [5] Robertson JA. Compensation and egg donation for research. Fertil Steril 2006;86(December (6)):1573–5. [6] Steinbock B. Payment for egg donation and surrogacy. Mt Sinai J Med 2004;71(September (4)):255–65. [7] Collins J. An international survey of the health economics of IVF and ICSI. Hum Reprod Update 2002;8(May–June (3)):265–77. [8] Egg Donation Law (5770-2010); 2010, Available from http://www.knesset.gov.il/privatelaw/data/18/3/289_3_2.rtf [17.1.10]. [9] Siegel-Itzkovich J. Israel permits ova donation from woman who is not undergoing treatment. BMJ 2006;333(September (7568)):569. [10] Schenker JG. Assisted reproduction practice in Europe: legal and ethical aspects. Hum Reprod Update 1997;3(March–April (2)):173–84. [11] Rabinerson D, Dekel A, Orvieto R, Feldberg D, Simon D, Kaplan B. Subsidised oocyte donation in Israel (1998–2000): results, costs and lessons. Hum Reprod 2002;17(May (5)):1404–6. [12] Schenker JG. Assisted reproduction practice: religious perspectives. Reprod Biomed Online 2005;10(3):310–9. doi: 10.1016/S1472-6483(10)61789-0. [13] Schenker JG. Assisted reproductive technology: perspectives in Halakha (Jewish religious law). Reprod Biomed Online 2008;17(Suppl. 3):17–24. [14] Zivotofsky AZ, Jotkowitz A. A Jewish response to the Vatican’s new bioethical guidelines. Am J Bioeth 2009;9(November (11)):26–30. [15] Navot D, Laufer N, Kopolovic J, et al. Artificially induced endometrial cycles and establishment of pregnancies in the absence of ovaries. N Engl J Med 1986;314(March (13)):806–11. [16] Serour GI. Bioethics in artificial reproduction in the Muslim world. Bioethics 1993;7(April (2–3)):207–17. [17] Yeprem MS. Current assisted reproduction treatment practices from an Islamic perspective. Reprod Biomed Online 2007;14(S1):44–7. [18] German EK, Mukherjee T, Osborne D, Copperman AB. Does increasing ovum donor compensation lead to differences in donor characteristics? Fertil Steril 2001;76(July (1)):75–9. [19] Gruen L. Oocytes for sale? Metaphilosophy 2007;38(2–3):285–308. [20] Ber R. Ethical issues in gestational surrogacy. Theor Med Bioeth 2000;21(2):153–69. [21] Shalev C. Halacha and patriarchal motherhood – an anatomy of the new Israeli surrogacy law. Israel Law Rev 1998;32(1):51–80. [22] Siegel-Itzkovich J. Israeli infertility experts investigated for ‘‘selling’’ ova. BMJ 2000;320(May (7247)):1425.
Contents lists available at ScienceDirect
European Journal of Obstetrics & Gynecology and Reproductive Biology journal homepage: www.elsevier.com/locate/ejogrb
Review
Ovum donation: examining the new Israeli law Benjamin F. Gruenbaum a, Zachary S. Pinchover b, Eitan Lunenfeld c, Alan Jotkowitz a,* a
Department of Medicine F, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel The University of Connecticut, Storrs, CT, USA c In-Vitro Fertilization Unit, Division of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 26 January 2011 Received in revised form 7 May 2011 Accepted 11 July 2011
Ovum donation affords countless couples that under natural circumstances would not be able to produce offspring the ability to carry out natural pregnancies. With advancements in biotechnology including egg collection and in vitro fertilization (IVF), physicians can now successfully implant fertilized embryos. Due to Israel’s tremendous involvement in IVF for its own citizens, the national laws that govern egg donation are of great importance. On September 5th 2010, the Israeli Parliament (Knesset) passed a law that allows young women between the ages of 21 and 35 to donate their eggs for paid financial compensation. The new law allows infertile women between the ages of 18 and 54 to request egg donation and IVF, which will partially be covered under state insurance plans. This article provides a description of the new Israeli law regulating ovum donation and the practical, moral and ethical debate surrounding the new system. ß 2011 Elsevier Ireland Ltd. All rights reserved.
Keywords: Egg donation Ethics In vitro fertilization Israel Law Ovum Religion
Contents 1. 2. 3. 4. 5.
Introduction . . . . . . . . . . The new ovum donation Religious concerns . . . . . Ethical considerations . . Future directions . . . . . . References . . . . . . . . . . .
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1. Introduction With advancements in biotechnology including egg collection and in vitro fertilization (IVF), physicians can now successfully implant fertilized embryos allowing otherwise infertile women to carry out natural pregnancies. In this process, potential donors are screened for various infectious and reproductive organs are examined to ensure their health. Ova are collected through a minimally invasive procedure under general anesthetics lasting on average 15 min [1]. Physicians are then able to artificially inseminate the extracted eggs and implant the embryo using IVF. Ovum donation, like other types of organ donation, has the ability to help many couples that under natural circumstances
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40 40 41 41 42 42
would not be able to produce offspring. Reasons of infertility may range from early onset menopause, middle-aged patients, underdeveloped or nonexistent ovaries and predisposition to genetic diseases [2–4]. The laws that govern ovum donation are complex and not uniform. The United States leads the world in the number of egg donations (E.D.) and has the highest rate of children being born through IVF-E.D. [5]. In some European countries including Spain and the UK, egg donation is less regulated while in others such as Germany and Italy it is more restricted [6]. Because the cost and regulation of IVF-E.D., medical tourism industries have become widespread in India, Thailand and other countries [7]. 2. The new ovum donation proposal
* Corresponding author at: Prywess Center for Medical Education, Faculty of Medicine, BGU, POB 151, Beer-Sheva 84105, Israel. Tel.: +972 8 6477415; fax: +972 8 647773. E-mail address: [email protected] (A. Jotkowitz). 0301-2115/$ – see front matter ß 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejogrb.2011.07.011
Due to Israel’s tremendous involvement in IVF both for its own citizens and Israelis’ coming from abroad, the national laws that govern egg donation are of great importance. On September 5th
B.F. Gruenbaum et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 159 (2011) 40–42
2010, the Israeli Parliament (Knesset) passed a law that allows young women between the ages of 21 and 35 to donate their eggs for a value set by the health ministry (Article 43) [8]. The law allows infertile women between the ages of 18 and 54 to request IVF-E.D., which will be partly covered under state insurance plans. This requires that the donor’s identity be kept confidential; however, IVF babies will be able to confirm their status with the court/Interior/Welfare Ministry after the age of 18 in an attempt to prevent interfamilial breeding (Article 36) [8]. The law also increases oversight and regulation on behalf of the government (Article 1) [8] while limiting a woman to a maximum of three donations with a three month interval between each intervention. The extraction of eggs must also be performed in Israel (Article 5) [8]. Before the passage of the law, egg donations were only permitted if the female donor underwent in vitro fertilization treatments that were deemed medically necessary yielding available ova [9]. Donors also had to provide eggs altruistically thereby prohibiting financial compensation despite reducing their chances to conceive due to ovum donation [10,11]. This created a great scarcity of available eggs, as many women were discouraged to donate eggs, forcing many Israeli women to travel abroad in order to obtain eggs from abroad via third party sources usually at tremendous costs. The new law will likely increase the number of Israeli women who desire E.D. treatment given that the availability of ova should increase with the new compensation measures and due to some of the costs being covered by national insurance. 3. Religious concerns Religion is an intrinsic part of the multi-ethnic Israeli culture with large religious populations including Jews, Muslims and Christians among others. The implications of the new law may undermine various religious convictions. The Chief Rabbis of Israel support both IVF and embryo transfer [12,13]. The Jewish perspective towards procreation originally comes from the first commandment in the Jewish Torah (Bible) that Adam received from God to ‘‘Be fruitful and multiply’’ (Genesis, 1:18). Thus, as long as no prohibition is violated, any method of procreation, including IVF and embryo transfer, may be used to produce a pregnancy [14]. Nevertheless, many Jewish authorities express concerns over the unclear religious status of children born via IVF-E.D., especially from non-Jewish egg donors. Orthodox Jewish law states that only offspring of a Jewish mother is considered to be born a Jew (Ezra 10:3). However, in regards to oocyte donation, there is a debate as to whether the oocyte donor or the women who physically gave birth to the child should be regarded as the mother [13]. For this reason, many rabbis suggest that any child born from an ova collected from a non Jewish mother should undergo a formal religious conversion once born. While the identity of the donor is kept anonymous, the Israeli law states that the religion of the donor is to be made known to the future parents in order to alleviate such problems. Furthermore, according to some opinions of Jewish law, the oocyte donor must be an unmarried woman, in order to prevent the possibility of the act to be considered a form of adultery [13]. Despite these concerns, assisted reproduction is generally an accepted practice, even among the orthodox. In fact, the first reported birth following ovum donation was of a religious Jewish patient and was performed under the permission of the Chief Rabbi of Israel [13,15]. While the collecting or wasting of sperm is generally forbidden in Judaism, these practices are ultimately allowed for the purpose of IVF [14]. Islam, the second most popular religion in Israel generally encourages IVF as a means to procreation, a duty that Islam regards highly [12,16,17]. However, it is preferred that IVF use gametes
41
from the parents that are trying to conceive. Therefore, oocyte donation is generally prohibited in Islam, since the two parties involved are not husband and wife and thus the act may be considered infidelity [3]. However, there exists the possibility of using eggs from a second wife and some Islam clerics have suggested this as a permitted option. The new Israeli law for ovum donation establishes a committee that can approve requests to allow individuals to designate a relative to receive their egg donation, given that there are religious reasons justifying such a donation (Article 22) [8]. The Catholic Church prohibits the donation of eggs either altruistically or for payment [12]. The Church views procreation and sexual intercourse as two inseparable phenomena, which must accompany one another. The Church forbids even the simple IVF where couples extract their own gametes but use IVF to maximize the chances of conception. Further issues revolve around the fact that IVF methodology often includes the production of excess frozen embryos that may never be implanted and are often discarded. The Church considers an out-of-body zygote as a fetus and is entitled to the rights of any human. Therefore any act that tampers or destroys a fetus is considered an act of abortion, and ultimately murder [14]. Similarly, the Church has issues with cryopreservation of such zygotes due to the potential harm and lack of respect the method may cause towards the zygote [14]. Therefore, in the case of egg donation, where a third party is used, ideal procreation in the eyes of the church is not accomplished and therefore forbidden by the church [6]. Thus, while many Christians have more liberal stances on this issue, Christians of the Catholic tradition would not drive benefit from the proposed law. 4. Ethical considerations When examining the ethical implications of widespread egg donation it is crucial to understand how such laws would affect the individual’s autonomy. The concept of autonomy demands that human beings have full control over their bodies and have the ability to make the choices they see fit. It is only possible to give true consent if the individual has autonomy and is making decisions freely. Before the passing of the new law, all egg donations in Israel were theoretically done on an altruistic basis and no financial or other compensation was provided. Donors typically underwent egg donation because they recognized an inherent value in procreation. Due to the lack of financial incentives, those that chose to donate their eggs most likely did so autonomously because they truly desired to help another individual making their consent valid [5]. With the passing of the new law, despite the governmental regulation, the financial incentives could undermine one’s autonomy and ability to make proper decisions. Therefore it is imperative that the compensation levels are high enough to cover the inconveniences and suffering that egg donors must incur during the egg collection process. However, if compensation levels are too high, payment can become coercive and many individuals might come to regret having donated which was a direct result of a difficult financial situation [6]. Such a case would be unethical because autonomy is compromised and proper consent cannot be given. While the exact compensation has yet to be determined, experts will attempt to insure that it will sufficiently compensate without causing unwanted or rash behavior. It is possible to test whether payment levels are appropriate by experimenting with compensation levels and determining how the volunteering egg donation population changes. Ideally egg donors should come from different socioeconomic and cultural backgrounds to ensure that financial compensation is not an overriding imperative [18]. For example if compensation levels only attract those earning in the lower income bracket, the financial compensation may be too influential
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and may need adjusting to ensure that those consenting are providing autonomous consent [18]. In the new Israeli context further research is needed on what effect financial compensation has on the socioeconomic makeup of the donors. If donors primarily come from lower socioeconomic classes the ethical principles of justice and social equality might be adversely affected. The major legislative change in the new law is the compensation that will be provided to egg donors; previously all donations were theoretically altruistic in nature. It seems ethical that the egg donors should be compensated for their services. The various researchers, scientists and physicians are all compensated for their services in egg extraction. Therefore it seems unjust that a major contributor to egg donation, the donator, would not be compensated. The new law recognizes this injustice and attempts to correct it by providing compensation to all those involved in the egg extraction process [19]. Yet, others state that financial compensation may lead to a situation where the woman’s body is treated simply as an object to use in the service of others [20,21]. In addition, it is crucial that before giving consent the donating woman is informed of all the potential health risks and adequate attention is given to her healthcare follow-up. The limitation of three donations is partly due to a concern for the woman’s health. Besides the ethical concerns before conception, there are also concerns about children conceived via egg donation and in vitro fertilization. The law will theoretically increase the amount of eggs available and hopefully lower the costs of IVF. This will allow many more couples to take part in infertility treatments allowing them to procreate. As the number of children born via IVF-E.D. continues to grow, it may be important that children are made aware in order to prevent partial inbreeding, which can result in greater risk for various genetic diseases [1]. The law does provide progeny of IVF the right at age 18 to determine their biological status while leaving the egg donor anonymous (Article 36) [8]; perhaps a more effective mechanism needs to be setup to notify these children. However, this needs to be balanced against the desires and needs of the parents which might make a mandatory notification system problematic from their perspective. 5. Future directions The law also has the ability to prevent corruption and illegal behavior that was not uncommon pertaining to egg donation and IVF [22]. Under the auspices of the Israeli ministry of health, egg donation will be closely monitored and controlled. Proper pre-egg donation testing will be administered to ensure that the eggs are free of disease and viruses. Compensation will be regulated for
donors and the costs of IVF will generally be covered for recipients ensuring that many can benefit from IVF treatments not only upper earners. The law seeks to protect the rights of the individual egg donors while providing more citizens with the ability to procreate despite the infertility syndromes they may be experiencing.
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