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Genetic testing and other technologies that offer a "window on the womb" are allowing parents to know more about their prospective offspring than ever before. Is that good? By Phil Berardelli
It is a wet, nearly freezing afternoon in early March. Dr. Glenn McGee, assistant professor at Penn's Center for Bioethics, maneuvers his purple Acura through midday traffic along slick streets in Center City Philadelphia. He is on his way to do a live interview with the MSNBC cable network on the ethical aspects of cloning. It is perhaps the 30th interview on the topic McGee has given in the few days since the shocking announcement that scientists in England had cloned a sheep
McGee, 29, is considered the most articulate and thoughtful of his generation of bioethicists by many older colleagues. Dr. Margaret Battin, professor of philosophy at the University of Utah, calls him "one of the highest-energy folks in his field" -- a quality that is very useful for someone whose work is often as much public as scholarly. His reputation is remarkable, given the brief timespan of his career. At 26, McGee had already finished his Ph.D. in American philosophy at Vanderbilt, passing his qualifying examinations before he even began graduate school and earning his master's and doctoral degrees in three years. His teacher at Vanderbilt, Dr. John Lachs, describes him as "a phenomenon" and "a storm of exciting ideas and activities who is still a nice guy."
By 1995, McGee was teaching philosophy at the University of Massachusetts, by all accounts a rising star, but somehow the conventional route wasn't satisfying. "Don't get me wrong," he says. "I liked teaching undergraduate courses in philosophy. But when I studied John Dewey and pragmatism in graduate school, the main lesson I took home was that philosophy works best when the eternal questions are connected to everyday practice." When he heard that Dr. Arthur Caplan, America's best-known bioethicist and a pioneer in philosophy of medicine, was setting up a new Center for Bioethics at Penn's School of Medicine, he resolved to jump in. "My letter said something like 'Dear Dr. Caplan, you would be nuts not to talk with me about the center.'"
Caplan was a little taken aback by the brashness at first, but he soon reconsidered. "I thought, 'Darn, I guess I really do want to interview this guy,'" he says. "And Glenn was right. His fit is perfect, including his ambition and drive."
McGee explains that what clinched the deal for him was Caplan's interdisciplinary approach to bioethics. Caplan says it was McGee's pragmatism and keen interest in genetics. Whatever -- there was synergy. Their unconventional first encounter quickly evolved into mutual respect. "I have learned so much from him about mentorship, public service, and the discipline," McGee says. He also was impressed with the Center's team, which includes specialists in history, sociology of science and medicine, economics, and health policy. "It's much easier to do good work in ethics with partners like those. Besides, Penn is the perfect place to do bioethics. There's so much pharmaceutical industry and clinical medicine in Philadelphia, New York, and Washington, and there's a real institutional commitment here to do novel research and teaching."
Brief career or not, McGee now firmly inhabits the strange space of the bioethicist, publishing as much in medical and trade magazines as in philosophical journals, and giving grand rounds and TV interviews as often as he produces scholarly papers. He continues to eschew conventional roles. This past year he turned down an attractive offer of a tenured position in philosophy in the Southeast. "I've gone whole hog on bioethics, and I love my job."
It's somewhat difficult to describe that job, because bioethics is still evolving. Two national commissions are working to define the credentials bioethicists need before they can work in hospitals. Others in the field work in philosophy departments, private companies, and law firms. That's how it should be, according to McGee. The "old" style of bioethics, which he describes as carrying a beeper in the hospital and responding to ethical alarms, has not been effective.
For McGee, bioethics means "first you dig up -- in a long and sometimes arduous conversation -- the philosophical and political context of a problem." This can mean both tough empirical work or thought experiments. Either way, the solutions should be feasible -- economically, scientifically, and socially. "If so, you can find the best way to employ the institutions you have at your disposal to solve the problem."
Which brings us to McGee's concept for the field's primary task: providing nothing less than a new social framework for making medical decisions. That requires bridging the formidable gap that exists between the medical and academic communities, the health insurance industry, the law, and the lives of ordinary people. Nowhere is this task more urgent -- and controversial -- than in genetics and assisted reproduction, the areas where McGee concentrates his time. His main concern is that genetic science has advanced much more quickly than the ability of social institutions to deal with its impact.
According to McGee, parenthood itself is changing. Parents are able to expect more, and know more, of their children before they are even born. "We are moving from an era where people 'had' babies to an era where we 'make' them," he says. As recently as the 1970s, most parents didn't have the window on the womb provided by ultrasound, genetic testing, and the new array of reproductive choices. "If you wanted to plan for a healthy baby, you could think about who you'd date, who you'd marry, how old you would be at the time of birth. That's it." Now, it's possible for couples to choose "sperm and eggs from strangers, sperm from your husband even if it can't swim, eggs from your Aunt Cheryl." Today, he says, designing a baby is becoming commonplace. "There are now more than 200 genetic tests! What's a mother to do?" Continued ...
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