Remembering the Life and Legacy of Robert D. Orr (1941–2021)

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For this issue of Ethics & Medicine, we offer a collection of essays and reflections on the life and legacy of Robert D. Orr, MD, CM (1941–2021). In addition to his many contributions as a clinician, clinical ethicist, scholar, educator, and professional mentor, Dr. Orr—or Bob as many of us knew him—served as a longtime editorial board member (1994–2009) and inaugural column editor with E&M for our Clinical Ethics Dilemmas series (2005–2009) and its predecessor series the Clinical Ethics Case Consultation (2002), and was a frequent contributing author to this journal over the years. When E&M expanded its editorial board to include a North American editorial board in 1994, Bob was part of that initial group.

I first met Bob when I joined the staff of The Center for Bioethics & Human Dignity (CBHD) in 2007 during his time as chair of the Center’s advisory board. One of the first major projects I worked on during my early years at CBHD was to help shepherd Medical Ethics and the Faith Factor through the publication process with Eerdmans Publishing. Recognizing that publishing his treasure trove of ethics consultation cases into that volume might impact source material for the Clinical Ethics Dilemmas series, Bob secured standing permission from Eerdmans allowing E&M to adapt his cases from that book and republish them with additional commentary from our column editor—a practice we continue to utilize today. Throughout my years working at the Center time and time again Bob was our standby expert across a vast spectrum of clinical/medical ethics issues, helping us field questions and interviews on topics from withholding and withdrawing treatment to physician-assisted suicide, POLST, medical decision-making, and clinical ethics consults. And, when we were looking to form a special interest group within CBHD directed to healthcare professionals (the Healthcare Ethics Council), Bob was keen to provide leadership as co-chair.

While I did not have the privilege of studying under Dr. Orr, I saw the impact he had as an educator on our bioethics students. Overwhelmingly, former students who took the clinical ethics course with him would speak with glowing praise about his case study method and more generally about how practical and beneficial the course was in their preparation and training for bioethics engagement. Indeed, several of the essays included in this issue are written by his former students spanning multiple institutions. Many of the students he mentored in our program have gone on to lead their own clinical ethics committees and incorporate his case study method and approach to clinical ethics consultation into their teaching as medical educators.

As an academic, he was an active contributor to the broader body of clinical/medical ethics and bioethics literature, having authored, co-authored, and co-edited several books and book chapters and numerous articles. Given his broader academic contributions in the areas of clinical ethics issues and ethics consultation, he was often a pioneering voice as an evangelical physician writing in Christian bioethics. From the articles and case studies he contributed over the years to E&M to his book chapters in CBHD’s Horizons in Bioethics book series and on to his broader contributions to bioethics and Christian bioethics, his work at the intersection of clinical/medical ethics, medical professionalism, and the particularities of the Christian faith are notable.

Appended to the end of this editorial introduction is a listing of the twenty publications he contributed to E&M over the years, followed by a select bibliography of some his key works in clinical ethics, medical professionalism, Christian bioethics, and the practice of Christian Hippocratic medicine. While many of the pieces we have selected to highlight are case study analyses, there is an impressive breadth of engagement across a wide range of audiences from popular-level publications like Christianity Today and First Things (and though not included in the list below the many pieces he contributed to Today’s Christian Doctor and its predecessor publication the Christian Medical and Dental Society Journal) and the co-authored books with NavPress and Baker Books and on to professional journals like AMA Virtual Mentor, Pain Medicine, and Southern Medical Journal and the variety of academic bioethics journals, including multiple commentaries with AJOB and several pieces each with Christian Bioethics,  the Journal of Medical Ethics and The Journal of Clinical Ethics. Several of these articles, including “Post-Christian Bioethics,” “Use of the Hippocratic Oath,” “A Process and Format for Clinical Ethics Consultation,” and “Autonomy, Conscience, and Professional Obligation,” among others, remain on my assigned reading lists for various courses. Each in their own way evidences the type of bioethical engagement that E&M has sought to cultivate from a Christian Hippocratic perspective—firmly committed to examining the challenges of emerging medical, scientific, and technological innovations and their clinical applications from within a Judeo-Christian worldview informed by the Hippocratic medical vision.

We begin this issue with a piece adapted from the transcript of his final plenary address delivered at CBHD’s 2016 annual summer conference, “Transformations in Care: An (Old) Physician’s Perspective.” Fittingly, the Clinical Ethics Dilemma column includes a case study adapted from Medical Ethics and the Faith Factor. These are followed by six essays written by former students and colleagues reflecting upon Dr. Orr’s contributions in bioethics and medical education, clinical practice, ethics consultation, and public policy engagement. As is our typical format, we conclude this issue with a pair of book reviews.

Chronological Bibliography of Robert D. Orr’s Publications in Ethics & Medicine:

• Review of Borrowed Time: A Surgeon’s Struggle with Transfusion-Induced AIDS, by Orville Messenger and Dorothy Messenger. Ethics & Medicine 12, no. 1 (1996): 18–9.
• Review of Coping with Controversy: Conflict, Censorship & Freedom within Christian Circles, by D. Gareth Jones. Ethics & Medicine 12, no. 1 (1996): 19–20.
• Review of Healing by Killing, by Nitzam Aviram. Ethics & Medicine 15, no. 1 (1999): 31.
• “A Clinical Ethics Perspective on Assisted Reproductive Technology.” Ethics & Medicine 16, no. 2 (2000): 51–54.
• “Clinical Ethics Case Consultation.” Ethics & Medicine 18, no. 1 (2002): 11–13.
• “Clinical Ethics Case Consultation.” Ethics & Medicine 18, no. 2 (2002): 33–34.
• “Clinical Ethics Case Consultation.” Ethics & Medicine 18, no. 3 (2002): 132–34.
• “Guest Commentary: Bioethics and the Fundamentalist Agenda.” Ethics & Medicine 20, no. 1 (2004): 3–5.
• Orr, Robert D. and Ferdinand. D. Yates, Jr. “Clinical Ethics Dilemmas: Is It Permissible to Shut Off the Pacemaker?” Ethics & Medicine 24, no. 1 (2008): 15–18.
• “Clinical Ethics Dilemmas: Continuing ‘Futile’ Support at Relative’s Insistence.” Ethics & Medicine 25, no. 3 (2009): 145–47.
• Orr, Robert D. and Gregory Rutecki. “Clinical Ethics Dilemmas: To Dialyze or Not to Dialyze?” Ethics & Medicine 26, no. 1 (2010): 11–14.
• “Will You Be a Provider or a Professional?” Ethics & Medicine 29, no. 3 (2013): 147–50.
• “Clinical Ethics Dilemmas: Choosing Birth or Death—Before Birth.” Ethics & Medicine 31, no. 1 (2015): 27–29.
• Orr, Robert D. and Ferdinand. D. Yates, Jr., “Clinical Ethics Dilemma: Surgery in Those Who Cannot Give Consent.” Ethics & Medicine35, no. 2 (2019): 79–81.
• Orr, Robert D. and Ferdinand. D. Yates, Jr., “Clinical Ethics Dilemma: Daring to Deploy a DNA Directive.” Ethics & Medicine36, no. 1 (2020): 37–40.
• Orr, Robert D. and Ferdinand. D. Yates, Jr., “Clinical Ethics Dilemma: Daring to Discharge.” Ethics & Medicine36, no. 2 (2020): 79–81.
• Orr, Robert D. and Ferdinand. D. Yates, Jr., “Clinical Ethics Dilemma: Daring to Discontinue Life-Sustaining Treatment.” Ethics & Medicine37, no. 1 (2021): 15–17.
• Orr, Robert D. and Ferdinand. D. Yates, Jr., “Clinical Ethics Dilemma: Religious Decision-Making in a Teenager.” Ethics & Medicine37, no. 2–3 (2021): 87–90.
• Orr, Robert D. and Ferdinand. D. Yates, Jr., “Clinical Ethics Dilemma: A Clash of Medical Cultures.” Ethics & Medicine37, no. 2–3 (2021): 91–94.
• Orr, Robert D. and Ferdinand. D. Yates, Jr., “Clinical Ethics Dilemma: Personal Choices and Future Medical Need.” Ethics & Medicine38, no. 1–2 (2022): 21–24.

Other Select Publications

• Orr, Robert D., David Schiedermayer, and David Biebel. Life & Death Decisions: Help in Making Tough Choices About Bioethical Issues. NavPress, 1990.
• “Get It in Writing.” Christianity Today 36, no. 4 (1992): 24–27.
• “Post-Christian Bioethics.” Christian Scholars Review 23, no. 3 (1994): 253–58.
• “Christian and Secular Decision-Making in Clinical Ethics.” In Bioethics and the Future of Medicine: A Christian Appraisal, edited by John Kilner, Nigel M. de S. Cameron, and David Schiedermayer. Eerdmans, 1995.
• “Confessions of a Closet Paternalist.” Western Journal of Medicine 162, no. 3 (1995): 279–80. https://pmc.ncbi.nlm.nih.gov/articles/PMC1022733/pdf/westjmed00055-0085.pdf.
• Orr, Robert D., David Biebel, and David Schiedermayer. More Life and Death Decisions: Help in Making Tough Choices About Care for the Elderly, Euthanasia, and Medical Treatment Options. Baker, 1997.
• Orr, Robert D., and Leigh B. Genesen. “Requests for ‘Inappropriate’ Treatment based on Religious Beliefs.” Journal of Medical Ethics 23, no. 3 (1997): 142–47. https://www.jstor.org/stable/27717930.
• Orr, Robert D., Norman Pang, Edmund D. Pellegrino, and Mark Siegler. “Use of the Hippocratic Oath: A Review of Twentieth Century Practice and a Content Analysis of Oaths Administered in Medical Schools in the U.S. and Canada in 1993.” The Journal of Clinical Ethics 8, no. 4 (1997): 377–88.
• “Hippocrates Meets Managed Care: A Study of Contemporary Oath-Taking.” In The Changing Face of Health Care, edited by John Kilner, Robert D. Orr, and Judith A. Shelly. Eerdmans, 1998.
• “Pain Management Rather Than Assisted Suicide: The Ethical High Ground.” Pain Medicine 2, no. 2 (2001): 131–37. https://doi.org/10.1046/j.1526-4637.2001.002002131.x.
• “The Moral Status of the Embryonal Stem Cell: Inherent or Imputed?” The American Journal of Bioethics 2 no. 1 (2002): 57–9. https://doi.org/10.1162/152651602317267989.
• “Addressing Issues of Moral Complicity: When? Where? Why? and Other Questions.” Dignity 9, no. 2 (2003): 1, 5. https://www.cbhd.org/dignitas-articles/addressing-issues-of-moral-complicity-when-where-why-and-other-questions.
• “Faith-Based Decisions: Parents Who Refuse Appropriate Care for Their Children, Commentary 1.” Virtual Mentor: AMA Journal of Ethics 5, no. 8 (2003): 291–95. https://journalofethics.ama-assn.org/article/faith-based-decisions-parents-who-refuse-appropriate-care-their-children-commentary-1/2003-08.
• “Pilgrimage and Profession.” HEC Forum 15, no. 4 (2003): 352–61.
• “Does Gray Hair Cause Gray Answers: Ethical Issues in an Aging Population.” In Aging, Death, and the Quest for Immortality, edited by C. Ben Mitchell, Robert D. Orr, and Susan Salladay. Eerdmans, 2004.
• Orr, Robert D., and Gilbert Meilaender. “Ethics & Life’s Ending.” First Things 145 (2004): 31–38. https://firstthings.com/ethics-lifes-ending/.
• “Relief Organizations with Counseling Restrictions.” Virtual Mentor: AMA Journal of Ethics 8, no. 12 (2006): 814–17. https://journalofethics.ama-assn.org/article/relief-organizations-counseling-restrictions/2006-12.
• “The Role of Christian Belief in Public Policy” Christian Bioethics 13, no. 2 (2007): 199–209. https://doi.org/10.1080/13803600701473489.
• “The Role of Moral Complicity in Issues of Conscience.” American Journal of Bioethics 7, no. 12 (2007): 23–24.
• “Responding to Patient Beliefs in Miracles.” Southern Medical Journal 100, no. 12 (2007): 1263–67.
• Medical Ethics and the Fath Factor: A Handbook for Clergy and Health-Care Professionals. Eerdmans, 2009.
• Orr, Robert D., and Wayne Shelton. “A Process and Format for Clinical Ethics Consultation.” The Journal of Clinical Ethics 20, no. 1 (2009): 79–
• Everett Jo P., Clifford A. Walters, Debra L. Stottlemyer, Curtis A. Knight, Andrew A. Oppenberg, and Robert D. Orr. “To Lie or Not to Lie: Resident Attitudes About the Use of Deception in Clinical Practice.” Journal of Medical Ethics 37, no. 6 (2011): 333– https://doi.org/10.1136/jme.2010.040683.
• “The Physician’s Right of Refusal: What Are the Limits?” Christian Bioethics 18, 1 (2012): 30–40. https://doi.org/10.1093/cb/cbs006.
• “Autonomy, Conscience, and Professional Obligation.” Virtual Mentor: AMA Journal of Ethics 15, no. 3 (2013): 244–48. https://journalofethics.ama-assn.org/article/autonomy-conscience-and-professional-obligation/2013-03.
• “Incorporating Spirituality into Patient Care.” Virtual Mentor: AMA Journal of Ethics 17, no. 5 (2015): 409–15. https://journalofethics.ama-assn.org/article/incorporating-spirituality-patient-care/2015-05.
• “To POLST or Not to POLST.” Examining POLST: A Special Report of The Center for Bioethics & Human Dignity, supplement, Dignitas 22, no. 4 (Winter 2015): S19–S20. https://www.cbhd.org/dignitas-articles/to-polst-or-not-to-polst.

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