Dr. Robert D. Orr was a committed Christian, good friend, and exemplary physician. His medical prowess and wisdom were perhaps most powerfully evidenced in his book Medical Ethics and the Faith Factor: A Handbook for Clergy and Health-Care Professionals. That book was the third project developed for The Center for Bioethics & Human Dignity’s (CBHD’s) second book series with Eerdmans, Critical Issues in Bioethics. His volume brilliantly demonstrates how the work of earlier books in the series produced by Biola’s Scott Rae and Harvard’s Arthur Dyck cash out in the everyday practice of medicine. It is a wonderful discussion of a great array of real-life case studies, filled with the insight that comes from a lifetime of faithful caring for patients in the service of God.
Category Archives: Commentary
Robert Orr, MD: Educator
I probably first encountered Dr. Bob Orr in Toronto—close to 40 years ago. We were both attending a conference—sponsored by the Christian Medical & Dental Associations (CMDA)—that was intended to be an introduction to faith-based medical ethics and would drum up interest for this relatively unheralded discipline.
Physician Exemplar of Faith and Reason: Robert D. Orr, MD, CM
Dr. Robert D. Orr stood out as a Physician, and one of integrity. That is to say, he was a fully integrated individual—theologically, philosophically, professionally, and personally—who engaged each patient and colleague with recognition of their own integrity.
The Science and Art of Bioethics Consultation: A Tribute to the Methodology and Teaching of Robert D. Orr, MD, CM
Is Dr. Orr’s approach to bioethics consultation unique? I cannot say, as I have not had another instructor in consultation methodology. Is his approach to bioethics consultation effective and efficient? That I can answer affirmatively.
In Remembrance of Robert D. Orr MD, CM: Physician, Mentor, Teacher, and Friend
I first met Bob Orr when I was a medical student and he was teaching a class on bioethics. He had recently started the clinical ethics consult service at Loma Linda University Medical Center (LLUMC), and I had had an interest in ethics since my undergrad days. Dr. Orr had reluctantly left his home in beautiful Vermont to come to the desert of Southern California and start an official ethics program at LLUMC. He was a Family Medicine physician by training; thus, he joined the Family Medicine department and served as one of the attendings who would chief in the residency clinic. Bob was a master teacher. His lectures were engaging and thought-provoking, and he knew that telling stories was the best way to help people understand what ethics was all about. For Bob, he believed that ethics meant treating people kindly and fairly. Ethics was not just an academic endeavor for Bob. He saw it as a way to make the world a kinder, gentler place for those who were often overlooked and disadvantaged.
Doing Clinical Ethics
“Dr. Orr, is this a situation where it would be permissible to withdraw care?” asked one of my classmates. Looking intently at the student and ensuring everyone was listening, Dr. Orr answered, “We may withdraw certain treatments, but we never withdraw care.” It has been 16 years since I heard Bob’s response to that student’s question. Whether I am teaching clinical ethics to medical students or discussing a complex case with members of my hospital ethics committee, I often find myself repeating Bob’s profound insight. His statement has the same impact on my students and colleagues today as it did on me in that classroom many years ago.
It has been 16 years since I heard Bob’s response to that student’s question. Whether I am teaching clinical ethics to medical students or discussing a complex case with members of my hospital ethics committee, I often find myself repeating Bob’s profound insight. His statement has the same impact on my students and colleagues today as it did on me in that classroom many years ago.
The opportunity to study clinical ethics with Bob was what ultimately convinced me to pursue an advanced degree in bioethics. I had heard him speak on this topic at a conference a few years prior, and I knew that spending time with him would make a significant difference in how I directed the ethics committee at my hospital and taught the residents and students in our family medicine residency. When I enrolled in Bob’s class, I had no idea that one day I would teach several courses with him, use his approach to clinical ethics to change how my hospital ran its ethics committee, and pass his teaching methods on to hundreds of students, residents, and colleagues. In the process, Bob became a friend and mentor. Not only did he help me grow in my understanding and practice of clinical ethics, but he also helped me appreciate the incredible privilege we have been given to serve God and our fellow human beings through medicine.
Ten Critical Ethical, Conceptual, and Clinical Cautions Concerning the Diagnosis and Treatment of Gender Dysphoria and Transgender Identification
Abstract
There is an urgent need for ethical, conceptual, and clinical clarity regarding the diagnosis and treatment of gender dysphoria and transgender identification. In this essay, I highlight ten critical concerns in this arena, namely, those involving: (1) conceptual parallels between sexual reassignment surgery and elective limb amputation; (2) the lack of long-term data that demonstrates reliable long-term relief from gender dysphoria in those undergoing hormonal or surgical treatment for gender dysphoria; (3) special problems with informed consent in the context of “gender affirming” treatments; (4) the importance of very high desistance rates of gender dysphoria and transgender identification, particularly in children, even without treatment; (5) the extensive differential diagnosis and the need for thorough and subtle assessments in the face of gender-related complaints; (6) a deep religiously based objection to transgender ideology involving the ordering of creation; (7) controversies concerning the existence of rapid-onset gender dysphoria; (8) the recent depathologizing of gender dysphoria; (9) the roles of genetics and environment in transgender identification and gender dysphoria; and (10) reflections on the role of psychotherapeutic treatment in patients with gender dysphoria and transgender identification.
Keywords: transgenderism, gender dysphoria, transsexualism, sexual reassignment surgery, gender affirming care
Revisiting Physician-Assisted Suicide: Reaffirming the Christian Hippocratic Legacy
Support for physician-assisted suicide is growing as a result of ever-expanding cultural pressure. Healthcare professionals should oppose this trend and recognize that physician-assisted suicide is a misguided answer to human suffering. For 25 centuries, the Hippocratic Oath has served as the ultimate credo of the medical professional, and serves as a more trustworthy guide for professional ethics than contemporary culture. In this essay, I reflect on the Hippocratic Oath from a Christian perspective and reaffirm that physician-assisted suicide, despite growing in cultural acceptance, remains a misled answer to human suffering and as such is dangerous for the profession of medicine. Physician-assisted suicide corrupts the medical profession, relies on a distorted view of autonomy, and subverts true compassion. The way forward for the medical professional, in contrast, is an ethic of a “good death” comprised of healing, palliative care, and true compassion.
First Principles for Medical Artificial Intelligence
Medical artificial intelligence (AI) technologies, by their capacity to decipher enormous data sets, identify meaningful patterns beyond what human intelligence can recognize, and in some cases render decisions without human assistance, are poised to transform healthcare. As with any powerful technology, careful ethical analysis is needed if we are to realize the benefits of AI while avoiding its perils. Four available perspectives are recognized. One perspective is technological sentimentalism, which resists novel technologies that seem to displace a more natural way of inhabiting the world. A second perspective is technological messianism, which uncritically welcomes novel technology as intrinsically good and the answer to all human problems. A third perspective, common today, is technological pragmatism, which weighs benefits and risks in a utilitarian framework that emphasizes empirical facts but disregards moral values, considering them to be opinions without consequence or validity. A fourth and preferred perspective is technological responsibilism, which considers not only outcomes but also the moral values laden in the design and implementation of technology. Technological responsibilism respects the deeply human attributes of voluntary responsibility, moral agency, and character. Morally responsible use of AI is needed if healthcare professionals are to sustain their focus, not on technology, but on patients.
Ethics of the Extreme
Extremism, which is variously regarded as the adversary of peaceful moderation or the vanguard of righteous dissent, often is immediately recognizable, but sometimes it may be ambiguous, insidious, or undefined. Growing apprehensions about mainstream extremism reflect a linguistic contraindication that may be a symptom of cultural disorientation. Insights from neuroscience suggest that some forms of extremism may arise from an imbalance of brain pathways involved in moral reasoning, such that those signaling sacred valuations and rule processing attain dominance over those representing empathy and deliberative reasoning. If the brain be compared to an orchestra, extremism would be analogous to the unpitched percussion section taking over, the bass drum and clash cymbals intruding into orchestral harmony and drowning out the string and brass sections with harsh, metronomic, auditory hyperintensity. And yet there is a proper role for these instruments. The ideal balance, whether of neural signals or orchestral voices, requires discernment of value beyond factual information. A number of ethical approaches supply moral clarity to assist with making ethical distinctions when convictions reach into the extreme, and while helpful, these leave unanswered deeper questions of ultimate meaning.