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.
Category Archives: Early Access
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.
Transformations in Care: An (Old) Physician’s Perspective
So, what I would like to talk about is a physician’s perspective on the transformation in care—changes in healthcare, changes in healthcare finance, and changes in healthcare ethics.
Book Review: Marilyn McEntyre, “Speaking Peace in a Climate of Conflict”
Marilyn McEntyre has succinctly written Speaking Peace in a Climate of Conflict as a guide for Christians to use words in ways to bring clarity and winsomeness to conversations and written communications.
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.
A Lady with Few Directives
QUESTION: How should we make decisions about resuscitation status for this confused woman with no designated surrogate?
STORY: Nellie is a 97-year-old woman who was living alone in her own home until she was admitted to the hospital four days ago with weakness, decreased mobility, and confusion. She was found to have pneumonia, sepsis, renal insufficiency, and dry gangrene of one toe. She has responded surprisingly well to treatment, but remains frail, somewhat confused, and is at risk of further complications. Dr. Roberts, who has not previously known the patient, has attempted to have conversations with Nellie about her wishes regarding resuscitation, intubation, and other end-of-life care, but she has given inconsistent responses. He believes that CPR with chest compressions is unlikely to work if Nellie’s heart should stop because of her very frail ribs—however, he is not absolutely certain.
The Moral Status of the Embryo in the Ethical Debate over In Vitro Fertilization
Abstract
On February 29, 2024, the Alabama State Legislature raised a national debate over the ethics of In Vitro Fertilization. The Los Angeles Times on March 4 declared the law’s assumption that the embryo is a person (and by extension would have moral status) must be opposed because it stifles the right of women to have abortions and use IVF. In this paper I argue that an embryo has moral status based on what I call its “organic destiny,” which reveals its goodness of existence. I explain this according to the inner directivity of biological life to mature through the stages of being an embryo, newborn, toddler, to adulthood. The biggest ethical problem with the procedure of IVF is what to do with the leftover embryos not used in the process. IVF per se does not necessarily overlook the moral status of the embryo, but to discard the leftovers because they are now superfluous would overlook and disrespect their moral status. Thus, for the procedure of IVF to recognize ethically the moral status of the embryo, it should proceed with only one embryo at a time.
Keywords: In Vitro Fertilization, Moral Status, Embryo, Organic Destiny, Aristotle, Bible
Bioethics and the Credibility Crisis, Part I: Diagnosing the Challenges Before Us
One key insight that emerged within postmodern philosophy is that facts and values along with meaning and significance are more intimately tied together than we may care to admit.
Aggressive Interventions for an Infant with Thanatophoric Dysplasia
Question: What medical and surgical treatments should be offered to an infant with a birth diagnosis that portends a lifetime of chronic problematic therapeutic needs?
History: Chelsea is a 7-week-old girl with thanatophoric dysplasia (TD) who has had a long and tumultuous hospital course since birth. Her diagnosis was discovered on prenatal ultrasounds, and her parents met with pediatric subspecialists, including both neonatology and pediatric palliative care. They received counseling on Chelsea’s diagnosis, its severe lung pathology, and poor survival rates. They discussed possible management and anticipated challenges, including the possibility that Chelsea would not respond to such interventions. The team and the parents focused on the “moment-by-moment” information gathering and decision-making in the delivery room, only briefly touching on the inevitable long-term support needs if Chelsea survived. Despite the counseling the parents received, they felt as if a trial of resuscitation was in Chelsea’s best interests after birth.