Last fall, Dr. Glenn McGee, assistant professor of bioethics and associate director for education at Penn’s Center for Bioethics, traveled to Britain as an Atlantic Fellow in Public Policy. There he found himself straddling the fault lines of an ever-shifting field in which the very essence of life is subject to cloning, patenting and politics. When he returned to Penn in the spring, McGee—who is also editor-in-chief of the American Journal of Bioethics and of the Basic Bioethics book series for MIT Press—fielded some questions from the Gazette about his experiences abroad.
Gazette: Can you offer any general observations
about the difference between the British approach to bioethics and the
American?
McGee: I went to Britain with typical American
cynicism about the ability of the English academic system to give practical
advice to policymakers about tough issues. I had worked with Ian Wilmut,
the Scottish scientist most responsible for cloning Dolly the sheep. Before
I was nominated to be a Fellow with an All Access pass to the British
government, I had laughed at the difference between our robust American
debate about cloning, and the tame pronouncements of a few philosophers
in Britain. How wrong I was. The British system for discussing policy
and practice in medicine only appears stodgy from 3,000 miles away. Up
close it is a beehive of ethical debate.
My research agenda—to
study the differences between U.S. and U.K. policy about reproduction—quickly
mushroomed into a comprehensive fire-fighting mission, as I was called
to participate in dozens of high-level conversations and task forces about
genetics, reproduction, patenting, biotechnology and the woes of national
health insurance. Where we have Camelot-style ethics debate in a powerless
presidential bioethics commission, the British involve ethics in literally
every stage of health policy and publish its implications on the front
page of every day’s paper. They don’t have bioethics as we know it, with
centers like the one at Penn, and in that respect they, like the rest
of the world, are playing a slow game of catch-up to develop our kind
of teaching and research skills. But what they have that we lack is a
profound integration of ethics and practice. Civility and a powerful role
for the prime minister really pay off in public policy.
Among the more profound
differences between American and British medicine is the way each sees
reproduction. To put it in ordinary language, the British put the analysis
of potential problems in reproduction ahead of the development of technologies,
while we Americans tend to rush headlong into developing technologies
and tend to see reflection on the ethical dimensions of reproduction as
either paternalistic or a matter for the market to resolve.
Take egg donation. Only
recently introduced to British medicine, and then only after the approval
of the British Human Fertilization and Embryo Authority, egg-transfer
from donors to other women who want to carry their children in their womb
requires several steps of interviews and approvals in the U.K. In the
U.S., we regulate the sale of parakeets more strictly than the donation
of eggs, and stories about how much money college women earn by “donating”
their eggs through Web sites, ads in Ivy League newspapers, and even on
EBay, will live on in the halls of medical fame.
Gazette: One often senses a strong anti-American
undercurrent among British intellectuals. Does that ever fuel bioethical
debates?
McGee: The British hate American
bioethics, but love it all the same. I was forever invited to lunch, dinner,
pubs, talks and even churches to sit quietly and listen to the Brits mock
our superficial and elitist health system, or to say a few words so that
an Oxford don would have someone to fight. I enjoyed that for a while,
but I really started to miss all things American, even the things I myself
had criticized about our health care, as I found all that I represented
under such constant attack. Study abroad, even in our cousin nation of
Britain, is a moving and emotional experience, in part because you are
a symbol almost all of every day. I took notice, for example, of the positive
effect a “British haircut” had; suddenly I didn’t get jostled as much
on the Tube or ignored in line at the grocery.
Gazette: I also sense more distrust of technology
and corporate business in general. Is that true (and relevant)?
McGee:
One of the most interesting developments while I was in Britain was the
American and British mutual interest in genetically modified [GM] foods.
I and most of my colleagues suspected that the reason the British distrust
GM foods was their love of the natural, their bucolic longing for a time
when things were unadulterated and real. Wrong. Lots of time and conversation
with dozens of those involved in or just watching the British side convinced
me that the U.K. distaste for genetically modified food is much more about
fear of what is viewed as an American carelessness with biotechnology.
We have much to lose in the global debates about biotechnology, and lesson
number one is to recognize the importance of demonstrating the safety
and benefit of each and every attempt to improve food before we bring
new food products to the market and the world.
Gazette: The recent joint statement by Clinton
and Blair opposing the patenting of genes caused some ripples in the biotechnology
industry,
and I gather you participated in that debate to some degree. What were
the subtexts of that statement?
McGee:
If everyone gets 15 minutes of time to communicate their message to the
world, I hope that the Clinton-Blair announcement doesn’t run down my
clock.
Indeed I did advise both sides about the announcement,
and in that sense I take some small measure of blame for the ridiculous
effect that statement had, though both sides ignored my plea that there
be a clear message about what counts as patentable subject matter. Instead
they made a strange statement that was toothless enough to encourage biotechnology
to keep patenting everything it does, while crushing investor confidence
in everything technological based on a false fear that both sides would
be banning patenting. It just goes to show how difficult top-down bioethics
can be, even in Britain.
Gazette: Any other recent shifts in British-American
bioethics that you’ve noticed and/or participated in?
McGee:
One of the most interesting developments while I was in Britain was the
announcement of an “intestinal pregnancy,” which happened when a woman’s
fetus attached itself to the lining of her intestines and was successfully
sustained by placental tissue that grew there. A prominent British researcher
interested in male pregnancy seized that and other developments to really
push the idea of getting men pregnant. I found that fascinating and had
a great opportunity to interview men who were potential candidates for
such a procedure. I plan to write about male pregnancy during the coming
months.
Gazette: That’s quite a bombshell. Could
you talk a little about the researcher who’s pushing this and some of
those potential candidates for the procedure?
McGee:
Male pregnancy, when it happens, will not be the offspring of some crackpot
British biologist. No less a scholar and scientist than the head of Britain’s
prestigious Hammersmith Hospital, Lord Robert Winston, a prominent reproductive
endocrinologist who conducted some of the most important early experiments
in in-vitro fertilization, is pushing the idea along. Winston believes
that there is no obvious reason why males should not share more fully
in the birthing process, and while I can’t see a big market for male birthing,
already I had the opportunity to interview several men who have volunteered
for clinical trials of this technology as it develops.
Gazette:Shock-value aside, isn’t
this a really bad thing to ask your intestines to handle?
McGee: Some of the obvious risks include rupture
of the intestinal lining, acute rejection of the fetus, and lord only
knows what sort of hormonal imbalance. But Americans, who warmed to the
idea of Arnold Schwarzenegger as a male mom in a 1980s movie, may be among
the first to have the opportunity to really spread the pleasures and burdens
of pregnancy around. As a philosopher I am fascinated at the implications
of male pregnancy for all of the ways in which we have traditionally defined
human flourishing. As a guy the whole thing has me fascinated yet oddly
repulsed. It promises to continue to be a rich area for ethical and scientific
research.
