Commodified Bodies: Is It a Gender Issue?
p. 325-339
Texte intégral
1At the beginning of the twenty-first century, the human body has become an ambiguous concept. Not only have questions arisen such as when does life begin and end, but even the boundaries of the body have become blurred. As Carole Pateman noted already in 2002: “Where lines are to be drawn about property and commodification, what should be alienable and inalienable, and where the balance should be between the two are some of the most pressing issues of the new century” (Pateman 2002). And indeed, in the first decade of the twenty-first century, numerous, unprecedented, and constantly evolving uses of human tissues, cells, stem cells, and DNA have emerged and changed our thinking about the human body and its legally defined boundaries.1 Components of the human body also carry important information about the whole body: for instance, DNA can be used to identify a victim, a genetic test may reveal susceptibility to a not-yet-manifested disease, and stored human gametes can be used for reproduction even posthumously.
2All this has led to the phenomenon already pointed out in 1996 by E. Richard Gold when he stated that we value not only the body as a whole but also its components, such as organs, tissues, cells, and DNA (Richard Gold 1996, 12). This fragmentation of the body for biomedical use, including the granting of independent value to detached components of the human body, inevitably raises the issue of the commodification and commercialization of the human body and its components. Certain uses of the body may even lead to exploitation. Commodification and commercialization are intertwined, but they reflect slightly different aspects of the consequences of this fragmentation. An increasing number of court cases indicate that the human body and its components have become a contested legal field (Curry 2002).
3In this chapter, I would like to argue that fear of the commodification and commercialization of the human body constitutes the main pillar of biomedical law in Europe. Furthermore, I would like to argue that commodification and commercialization have hidden gender implications that often make it difficult to explore whether we are faced with exploitation based on discrimination against women or a new form of commodification resulting from new biotechnologies.
European law, commodification and commercialization
4The law applies the notion of commodification to separate between things and persons, and argues that the person cannot be commodified or treated as a proper object for sale and purchase. This prohibition has been extended to the human body as a whole and even to its component parts as a general principle, based on the integrity of the human body and the person to whom the body belongs. When human genes and tissues are in question, the notions of commodification and commercialization have to be re-interpreted. They become salient in biomedical law and even criminal law when genes, organs, and tissues are exchanged for financial benefits.
5A major European instrument in this field is the Convention on Human-Rights and Biomedicine (the Oviedo Convention),2 which imposes a categorical ban on the commercialization of any part of the human body. Its Article 21 specifically stipulates that “[t]he human body and its parts shall not, as such, give rise to financial gain.” The convention enjoys widespread support in Europe. Several important court cases have elaborated this principle more fully and in different fields—not solely in organ donation but also in stem-cell research and reproduction. It is especially remarkable that, to date, no European or other signatory country has expressed any reservation about the Oviedo Convention’s categorical ban on financial gain, despite the fact that in several contemporary fields of biotechnological interventions, it is rather difficult to draw any clear distinction between non-commercial and commercial domains of activity.
6Although the Oviedo Convention has not been ratified in all European countries, its influence is far greater than it seems for at least two reasons. One is that an increasing number of cases before the European Court of Human-Rights refer to the Oviedo Convention, and the other is that the European Commission included compliance with the Oviedo Convention as a precondition for European Commission funding of research projects in the field of biomedicine. In some countries, however, the Oviedo Convention has not been regarded as providing sufficient guarantees for protection of the human embryo.
7The norm against commodifying human beings can be traced back to the elimination of slavery. Slavery—and other institutions under which the whole human body has been historically degraded into an instrument for the arbitrary use by the “owners” of this “property”—has long been banned by international and national laws. Unlike slavery, however, the commercialization of certain parts or elements of the human body has never been universally prohibited throughout the world. As new scientific advances and technological developments have emerged involving components of the body rather than the whole body—in the fields of assisted reproduction, surrogacy, genetic testing, biobank collections or stem-cell research, for example—sharp lines between therapy, research, and commodification have become more and more difficult to draw.
Gender implications of commodifying the human body
8Looking at certain specific components of the human body I will show that commodification and commercialization contain both hidden and explicit gender implications. Although the body is often ignored in biotechnological interventions (“the lady vanishes”)3, and although the fragmentation of the human body may also turn the male body into a source of raw material, it is still worthwhile analyzing how gender differences become salient in such biomedical interventions. Gender differences seem to be less relevant in cases of organ donation, DNA sampling, or recruitment of donors for biobanks. But when one refers to human gametes both in reproduction and in biomedical research, gender differences seem to be highly germane. Eggs are needed in large quantities not only in the processes of assisted reproduction but more and more in the domain of regenerative medicine. “Unimaginable until the twentieth century, the practice of clinically transferring eggs and sperm from body to body is now part of a multi-billion dollar market” (Almeling 2011). Since a sufficient number of eggs can be harvested only by using hormonal stimulation for some weeks before the intervention and because eggs cannot be harvested as often as sperm, the two procedures differ both biologically and emotionally. Moreover, the in vitro fertilization industry targets mainly women, just as infertility still casts different social stigma on men and women, and most medical interventions are done on women’s bodies. Hormonal stimulation before harvesting human eggs, egg donation, embryo implantation, amniocentesis,4 chorionic villus sampling,5 pregnancy monitoring, prenatal testing, and birth all contribute to the medicalization of the female body. The male body is affected to a much lesser extent. Such biological differences may result in eggs being considered a scarce resource.
9Old debates about sexualized and gendered bodies have been renewed due to contemporary biotechnological developments since not only the frontiers of life and death have become problematic (when patients are in persistent vegetative state, or a pregnant woman in coma, etc.), but even the boundaries of the natural human body have become increasingly ambiguous (e.g., in the status of the cryopreserved embryos, gametes, mitochondrial “mothers,” human DNA in biobank, etc.) (Sándor 2007). Do cryopreserved gametes, tissues, DNA, and umbilical-cord blood stored for the purposes of the donor’s own therapeutic use, or for the use of other family members or for others or for research constitute a part of the human body? What kinds of rights over these samples can be retained by those persons to whom these tissues used to belong? Donna Dickenson describes these changes by stating that the human body has become “much more fluid. On the one hand, bodily functions can be replicated or enhanced by objects originally extraneous to the subject, machines such as ventilators and pacemakers… on the other hand, human biomaterials extracted from the body enter into research and commerce as objects…” (Dickenson 2007, 5).
10Dismemberment of the human body and subsequent exploiting of its detached elements for research and analysis may eradicate existing gender differences. Fragmentation of the human body, however, may also renew the experience of vulnerability previously known only to women. Donna Dickenson argues that “women were much more likely than men to be treated as commodities in non-slave-owning systems” (Dickenson 2009, 163–164). In the Anglo-American legal system the concept of “coverture” was the main rule governing marriage, and it followed that husbands had the rights to manage women’s income and labor. Rape in marriage was not regarded as a crime in several other jurisdictions, as well. In marriage contracts, unlike other types of contract, continues Donna Dickenson, “the enforcement mechanism worked almost entirely in one party’s favor: the husband’s” (Dickenson 2009, 164). She sees an analogy between these traditional marriage arrangements and contemporary agreements on using biological tissues and cells for research: only one party can benefit, and it is not the one who is in the more vulnerable situation. The patient waives any financial benefits that may arise after his or her tissues are used in research. Based on this analogy, Dickenson goes further and argues that current biotechnological practices, especially collecting human cells and tissues on a mass scale, have resulted in the feminization of the human body. Taken together, all these practices have resulted in the “fear of feminization of property in the body” (Dickenson 2009, 165).
11In history, women were more often identified with their bodies but without possessing ownership over them and over their reproductive capacities. This delicate relationship between body and identity, body and control historically was an important experience of women and was reflected upon and challenged by feminist theory. It is easy to recognize a parallel trend in contemporary biotechnology, where in the time of biobanks and stem-cell banks human tissues and cells are being used more and more in the same way as women’s bodies were before. Human tissues and cells are now objectified, alienated but considered as a gift or donation from the donor. Furthermore, it is assumed that human biological materials are used for noble common purposes, such as for science and for public health. Similarly, previously women were assumed to be born altruistic and to be able to sacrifice themselves for children, for family and for the patriarchal society, but without having basic rights, such as liberty and property. So we can agree with Dickenson, in this sense, that in biotechnology human cells have been feminized. Rights are asymmetrical and altruism is assumed in donation.
12Debates on the body as an intrinsic good or as part of the human personality have become far more complex due to new biotechnological interventions, and because we value not only the human body but also its components as forming part of our identity. Sometimes we value its components, such as DNA, because they represent or signal our uniqueness; and sometimes we value our body parts because they represent physical integrity and health. Loosing a leg or a kidney interferes gravely with bodily integrity and also presents serious health risks. Some other body parts, such as blood or plasma, usually do not raise such issues, although we do feel that a coercive taking of such specimens violates our right to bodily self-determination. Disassociated body components have also become more and more significant. DNA is an obvious example that symbolically represents the whole biological person. But egg and sperm, too, refer to important features of personhood and may be used for discovering important information or, in the case of gametes, can be used for reproduction.
13A second question follows from the first: If personal rights provide the key to resolving legal questions about human body in biotechnology, then does gender make a difference? In other words, do men and women face different legal problems when their organs, gametes, and DNA are in use in biotechnology? The distinct experience of women in health-care and reproduction has been broadly studied and elaborated. Works of Emily Martin (1987), Judith Butler (1993), Barbara Duden (1991), Ann Oakley (1984), and Margaret Lock and Sarah Franklin (2003) can be cited in this regard. The association of femininity with materiality, according to Butler, “can be traced to a set of etymologies” (Butler 1993, 31), a link between mater and matrix (uterus, womb) and mater and materia. Furthermore, Aristotle emphasized (in On the Generation of Animals) that while in reproduction men provide the “form,” women provide only the “matter,” which is inferior to the form. While, according to him, men supply the substance of a human being, the soul, women contribute only with nourishment (the matter). The materiality of the body, in other words, seems to have long been associated with femininity.
14Many gender issues concerning the body—such as the limitation of any right to bodily self-determination, vulnerability, and repeatedly suppressed reproductive rights—indicate that discrimination and misogyny still influence practices and thinking about women. This syndrome is the primary target of progressive emancipatory policies and laws. The hidden biases that associate women’s bodies with raw materials are much more difficult to counter with legal and policy methods because, for one thing, they often remain unconscious practices and routines. Discrimination, vulnerability, and society’s expectations about reproduction often place women in situations where their bodies are exploited. Sex slavery and prostitution predominantly affect women. Moreover, economic crises inevitably push women into these forms of exploitation. Bride kidnapping and child brides still occur despite repeated efforts to promote women’s rights as human-rights. The question is whether these practices of commodification and exploitation of women’s bodies also influence the uses of tissues that are extracted from women.
15None of the above-mentioned problems have ever been fully solved. In most parts of the world, although to a lesser and lesser extent, they still influence thinking about male and female bodies. To many other scholars it seems that gender differences are still relevant even if it is at the level of genes and chromosomes (Rapp 1988). One conspicuous example of this continued trend is the way that sex-based migration patterns are studied in population history: different methods are applied when looking for female or male ancestors. Since genetic studies in population history provide comparisons of mitochondrial DNA and the Y chromosome, they ultimately provide insight into gender differences as well. So while mitochondrial DNA is maternally inherited and shapes female demographic history, the non-recombining portion of the Y chromosome reflects male demographic history. In contemporary biobanks, researchers collect samples both from males and females. While so called “gene donors” are assumed to provide their biological contribution free of charge, gift and donation rhetoric seems more problematic in the field of reproduction. Egg donation for instance requires hormonal treatment and an invasive medical intervention for harvesting the eggs. When egg donors are recruited for research purposes the meaning of “gift” is seriously questioned.
16While, in many fields, women’s rights have significantly developed in the United States (US), no progress has been made in the field of reproduction and related new technologies. One may observe recurrent infringements of pregnant women’s rights. Donna Dickenson claims that US market forces have proven irresistibly powerful, and that those who wanted to argue against commercialization were unable to do so because they had relied on it themselves in the “abortion wars.” Because of the highly politicized and polarized abortion debates, other fields of reproduction, such as infertility treatment, egg donation and surrogacy have been neglected by the US federal regulations. As a consequence, it has become difficult to assess women’s rights in two distinct fields: in the classical field of reproduction, such as in the field of abortion and sterilization, and in the field of new reproductive technologies (Goodwin 2005). In an accurate legal analysis, liberty and privacy rights in reproductive decisions—though closely connected—should still be separated from issues of commodification.
Commodification of gametes
17Egg selling has been deemed controversial since the beginnings of in vitro fertilization. In vitro fertilization is offered at for-profit private clinics in many parts of the world. But patients’ rights dictate non-commodification in this sector as well. Some tension between remunerative practices and the outlawing of financial gain was doubtless inevitable. What we have seen is increasing commercialization in the egg market, as well as price differentiation between the gametes and even advertising.
18Individuals’ expectations differ radically in relation to their own body, to biological specimens and to the cells, tissues, organs borrowed, used, bought, or received from the others. While dignity and privacy with regard to our own body assumes the unity of person and body, in case of using surrogate mothers, egg and semen donors, embryos, embryonic stem-cell products and even the quality of these products all suggest a property-like treatment of the human body.
19Using human oocytes as raw materials for reproduction and research purposes poses perhaps even more complicated legal questions. Should women be compensated because they contribute their eggs to scientific development? If they cannot claim benefits after egg donation, could companies and researchers use eggs for profitable research? Should the limited number of eggs be taken into account? What about the physical and psychological suffering that harvesting human eggs may involve?
20In the years following the Hwang scandal6 in Korea in 2005, an international debate arose among bioethicists, researchers and feminists regarding oocytes for research, particularly concerning the acceptability of payment (Dickenson 2007; Waldby and Cooper 2008). In 2009, Hwang was convicted of misusing research funds and illegally buying human eggs for his research. His team persuaded women to donate their eggs (oocytes) for their somatic cell nuclear transfer (SCNT) research. Investigations revealed that many of the women who provided eggs had not given valid, informed consent, and nearly 75% of them reported that they were given cash or were enticed by various financial incentives (Baylis 2009).
21According to Ingrid Schneider, if stem-cell therapy is eventually introduced and the technology still requires human eggs, then “every woman in the US aged 18–44 (around 55 million) would have to endure two cycles of ovarian hormone hyper-stimulation and then undergo laparoscopic surgery” in order for a sufficient number of eggs to be available for treating Parkinson’s, diabetes, and Alzheimer’s diseases. When eggs are used for research and when eggs are bought, donors are thought to receive payment for risking their health. It is as if commodification of gametes could mask the fact that we are dealing with a medical intervention where risks should be minimized and the well-being of patients (donors) should be prioritized. Commercial donors are often not treated as patients. Money is often interpreted as payment for the risk involved. It allegedly justifies harvesting rather than treating the human body. Those who argue in favor of commodification, on the other hand, often claim that, in the absence of payment, the whole “donation” process may degenerate into one-sided altruism.
22Payment for egg donation is a challenging question precisely because egg donation requires a substantial contribution from women. It not only involves a genetic contribution; it may also diminish the donor’s future reproductive chances, as well as inflicting pain and suffering, and risking the medical complications that hormonal stimulation and egg retrieval may potentially entail. True, spare eggs may be accessed in the course of an IVF treatment; but it remains important that human eggs are not unlimited resources and that harvesting human eggs includes a variety of physical and psychological commitments. Harvesting human eggs requires hormonal treatment, and the procedure is a surgical operation carrying significant health risks. Certain biological differences between gametes have already posed significant legal challenges in the Evans v. The United Kingdom case (Application no. 6339/05). In the light of this case, British law and the court’s position assume a kind of co-ownership or property held jointly by the parties, as the embryo contains genetic materials from both parties. This joint contribution was regarded as more important than the differences in egg and sperm donation, namely the differences between invasive and non-invasive medical procedures and the importance of vested interest and suffering. Here again, as in many cases involving new biotechnologies, gender has to be reinvented again and again.
23Citing Dickenson (2007), Waldby and Cooper (2010) also confirm that in the field of regenerative medicine female bodily productivity is mobilized to support bio-economic research, but this economic value remains largely unacknowledged by claiming that compensation for bodily productivity may contradict the principle of non-commodification. For those scholars who make a distinction between paying for an organ/egg and paying for labor, efforts, and inconvenience argue that payment for egg donation is not paying for the gamete as such, but paying for producing eggs for research or reproductive purposes. Unfortunately this view does not save us from the commodification of the eggs and the possibility of exploitation. If women’s eggs are more expensive than donated sperm, than it is inevitable that impoverished women will feel more pressure to sell their eggs in order to help themselves and their families.
24Another consequence of egg commodification is the rise of competition among in vitro fertilization clinics. In other sectors of the economy, competition may result in better quality products and faster services, but in the field of infertility treatment, when clinics follow an unregulated business model, better services inevitably mean selecting egg donors and making more effective egg harvesting protocols to acquire more gametes and provide more pre-implantation genetic services. All of these elements of fertility enhancement shift infertility treatment toward eugenic selection and the over-medicalization of procreation and pregnancy.
Commodification and commercialization of the womb
25Surrogate motherhood is prohibited in most of the European countries on the grounds that it may lead to exploitation of the surrogate mother. In some other countries, when assisted reproduction is regulated, the law often remains silent on the status of the surrogate mother. In the third category of countries, such as the US, where assisted reproduction is unregulated, case law provides some guidance on the status of the surrogate mother.7 In the US, one of the most well-known cases was the Baby M case8 in which the Supreme Court of New Jersey was asked to determine the validity of a contract that aimed to provide a surrogate’s help to bring a children into a family, and which is also discussed in Seema Mohapatra’s article in chapter 2 of this book. The surrogate mother received a fee of $10,000, and she agreed to be artificially inseminated with the semen of another woman’s husband; she was to conceive a child, carry it to term, and after its birth surrender it to the natural father and his wife. The contract provided that through artificial insemination using Mr. Stern’s sperm, the embryo would be carried by Mrs. Whitehead (who was also the genetic mother of the child). After delivery she would give the child to the Sterns. Mrs. Stern could thereafter adopt the child. Interestingly, Mrs. Stern was not a party to the contract, but Mrs. Whitehead’s husband was. This obvious gender discrimination should have served as an early indication that there were problems with the agreement. While trial court considered the surrogacy agreement valid, the New Jersey Supreme Court came to a different conclusion and invalidated the surrogacy contract because it conflicted with law and public policy. The Court specifically referred to the role of the monetary incentive paid to the surrogate mother, and, as the Court emphasized, the payment “depending on her financial circumstances,” served to “make her decision less voluntary.”9 Furthermore the court argued against exploitation. “Baby-selling potentially results in the exploitation of all parties involved.”10
26In the United Kingdom (UK), while commercial surrogacy is prohibited, surrogacy agreements without payment are tolerated even though they are not treated as enforceable. Special problems may occur when couples seek to enter into surrogacy agreements elsewhere. In Europe, though not (yet) part of the European Union, Ukraine allows commercial surrogacy. This has already resulted in several legal cases of British and French couples going to Ukraine in order to have babies through surrogacy agreements. In Ukraine, surrogacy is allowed both by the Family Code11 and by the ministerial decree on the Approval of the Instruction on the Use of Assisted Reproductive Techniques. While Ukraine is a signatory to the Oviedo Convention, it is interesting that the prohibition on financial gain was not seen to contradict the commercial form of the agreement in surrogacy contracts. Under Ukrainian law, would-be parents who initiate an assisted reproductive procedure are considered automatically as parents of the child.
27In the case of X & Y [2008]12 in the High Court of Justice, Family Division in London, the main question was how to settle problems arising when twins born from a surrogate mother in Ukraine were not recognized as British citizens, and remained stateless and legally parentless. The applicants in this case paid €235 per month to the surrogate mother during pregnancy and a lump sum of €25,000 on the live birth of the twins. This payment was lawful under Ukrainian law. This payment, however, exceeded legally allowed expenses under English law. As a result, the court had to determine whether the sum paid to the surrogate mother was disproportionate to reasonable expenses and whether the applicants acted “in good faith and without moral taint” in their dealings with the surrogate mother.13 These cases indicate that, in global surrogacy arrangements, international legal instruments should govern solutions of these hard cases. As it can be seen, prohibition of commodification alone does provide a satisfactory solution in these complex cases, as several questions of human-rights—the rights of the child, reproductive rights, human dignity and gender equality—are also involved in cross-border surrogacy cases.
Conclusions
28We are living in a time when biological samples extracted from men and women have increasingly become raw materials for biotechnological research, for reproduction, and for regenerative medicine. The objectification, commodification and commercialization of the body, which once used to be the experience of women only, have now become a more general practice in biotechnology and even in health-care. Health-care and biotechnology have become more closely connected with each other than ever before. This makes it difficult to argue by invoking classical human-rights principles alone, including the right to health, even in the European jurisdiction where such a right is recognized. As we have seen, the same phenomenon of accelerated commodification can be observed in the field of IVF treatments, egg donation, surrogacy, stemcell therapy, umbilical-cord-blood banking and even in the case of biobanks and patenting. In the field of organ transplantation, similarly, several experts argue for economic incentives and payment for organs, basing their views on organ scarcity, which is itself a concept attached to commodity. The European approach, in general, was to develop a general non-commodification principle, which seems to have become less and less defensible. Like it or not, the current process of objectification of human tissues and DNA may seem inevitable, and donors may have to accept this seeming inevitability regardless of their gender. My brief overview of current practices in biotechnology reveals trends of increasing commodification and commercialization. Imbedding gender in this analysis was helpful to the extent that current commodification trends replicate challenges that have been already identified and debated extensively in gender studies.
Bibliographie
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References
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Notes de bas de page
1 In 2011 the Nuffield Council on Bioethics has published a report on “Human bodies: donation for medicine and research” in which it states that “[T]he increasing possibilities for using bodily material in treatment and research, and the health effects of changing lifestyles, have led to high demand for all kinds of bodily material.” See nuffieldbioethics.org/wp-content/uploads/2014/07/Donation_full_report.pdf, last accessed on January 14, 2014.
2 Convention for the Protection of Human-Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human-Rights and Biomedicine, Oviedo, 4.IV.1997.
3 The term is applied by Donna Dickenson.
4 Amniocentesis (also referred to as amniotic fluid test or AFT) is a medical procedure used in prenatal diagnosis to detect chromosomal abnormalities and fetal infections.
5 Chorionic villus sampling (or “chorionic villous sampling,” CVS) is a form of prenatal diagnosis to determine chromosomal or genetic disorders in the fetus. It entails sampling of the chorion villus (placental tissue) and testing it for chromosomal abnormalities.
6 Hwang was considered as a national hero in Korea for his stem-cell research. His research activities were halted when his success in somatic cell nuclear transfer (SCNT) became mired in scandal, particularly when it emerged that many of his data on SCNT were fabricated. He lost his university position and his two important papers on embryonic stem-cell research had to be retracted from the journal Science.
7 There are many cases on the dispute over babies, such as In the Matter of Baby M, 217 N.J. Super 313 (Ch. Div. 1987), In re Baby M, 537 A. 2d. 1227 (N.J. 1988)
8 In the matter of Baby M, 109 N.J. 396; 537 A.2d 1227; 1988 N.J. LEXIS 1; 77 A.L.R.4th 1.
9 Supra [1242].
10 Supra [1242].
11 zakon4.rada.gov.ua/laws/show/2947-14 (accessed on 20 January, 2014).
12 X & Y (Foreign Surrogacy) [2008] EWHC 3030 (Fam).
13 Ibid., at 21.
Auteur
Full professor at the Faculty of Political Science, Legal Studies and Gender Studies of the Central European University (CEU), Budapest, Hungary. She has participated in many national and international law and policy-making activities in the field of biomedical law and bioethics. In 2004–2005 she served as the head of the Bioethics Section at the UNESCO. She has published seven books in the field of human-rights and biomedical law. Since 2005, she has served as a founding director of the Center for Ethics and Law in Biomedicine (CELAB) at the Central European University.
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