Robert Orr’s Legacy of Theologically Rich Clinical Ethics Leadership

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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.[1] 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.

I remember picking up Dr. Orr at the airport in the summer of 2018 when he flew to Chicago to make a presentation at CBHD’s annual conference. Over lunch en route to the Trinity International University campus we reflected over the many projects he had tackled in his life. His Medical Ethics and the Faith Factor stood out especially in his mind. He fondly remembered clearing enough space in his busy schedule to spend some time writing the book in what had been the home of C. S. Lewis in England. As he reflected on the records of countless sessions with patients, he was overwhelmed by how the guiding hand of God had consistently been upon him—the “Faith Factor” indeed.

Dr. Orr’s well-known case study book reflected his experience with 1,500 case consultations. The first of the book’s four major parts consists of two chapters, one “An Ethical Foundation” and the other “A Theological Foundation.” Yes, Dr. Orr’s medical credentials and experience were exceptional. But over a lifetime he demonstrated again and again how secular ethics and theological ethics can work together to provide better medical guidance to every person than the practice of medicine can provide without them.

His emphasis on including, not excluding, theological insights made him a great person to provide leadership for CBHD’s engagement with medical challenges. For example, when CBHD was just getting started, it needed to become known but did not have funds for advertising. Instead, it was decided to make its special blend of clinical and theological ethics known by holding conferences around the US led by a clinical ethicist and a theological ethicist.

Five “Breathtaking Decisions” conferences were advertised nationally at once, with dates ranging throughout 1995 and locations ranging from Washington, DC to Los Angeles to Naples, FL and places in between. The teaching team consisted of two clinical ethicists (Robert Orr and David Schiedermayer) and two theological ethicists (Nigel Cameron and myself), with one of each type constituting the pair of leaders at any given seminar. Dr. Orr was enthusiastically received at these conferences and found that people had more interest than he imagined in the case study work that was his specialty.

In light of the consistent success of these events, multiple regional bioethics conferences in the US and abroad quickly became a mainstay of CBHD’s efforts. Dr. Orr and I worked together particularly well, so many of these “Breathtaking Decisions” conferences were led by the two of us together, including in Fargo, ND (1997), Hershey, PA (1999), Memphis, TN (2001), Canton, OH (2001), and Ft. Lauderdale, FL (2003). Numerous other such CBHD events included different speaker pairs, occasionally including Dr. Orr (such as in Columbus, OH during 2000). A few locations wanted to tailor their events in certain ways, and Dr. Orr was happy to accommodate. He let his case study expertise shine at such other regional CBHD conferences as “Reproductive Technology, Human Rights, and the Law” (Anaheim, CA, 1996) and “Cutting-Edge Bioethics: Human Life on the Line” (Dallas, TX, 2005).

While these regional events fostered national and later international visibility for the Center, the strategic importance of CBHD hosting a larger national/international conference in its home location was recognized from the outset. There was a need for theologically inclined people to gather together annually to wrestle through a particular bioethical challenge. To catalyze that, there was a need to have on hand a group of the best national and international thinkers on that subject. Their role was not only to present talks on that topic but also to collaborate on a book each year to help educate far more than the number of people attending the conference. That annual series of books became known as CBHD’s Horizons in Bioethics series (published by Eerdmans). Its initial annual conference, in mid-1994, was on “Bioethics and the Future of Medicine.” That became the title of the book released the next year, developed from the conference plenary addresses.[2]

Needless to say, Dr. Orr’s conference address and book chapter that initial year were stellar. His presentation, titled “Christian and Secular Decision-Making in Clinical Ethics,” reflected his very special role in the church and the world.[3] Whereas most people—including those engaged in the field of bioethics—address mainly Christian audiences or mainly secular audiences, Dr. Orr was equally at home in both. Yes, he served as the Director of Clinical Ethics for CBHD; but he also held the same position at the University of Vermont College of Medicine. Yes, he served as a professor in Trinity International University’s Christian bioethics Master’s program; but he also held the same position in Union University (New York) Graduate School’s secular bioethics program.

Dr. Orr’s special ability to understand and compare secular and Christian outlooks made him an unusual blessing across the worldview divide—fostering understanding and even collaboration where possible. CBHD named the Robert D. Orr Endowed Fellowship in his honor, an honor echoed by the Endowed Lectureship in Medical Ethics of Christian Medical and Dental Associations. But equally well-earned were such secular honors as being named Vermont Family Doctor of the Year and receiving an award from the American Medical Association for “Leadership in Medical Ethics and Professionalism.”

Three years after the initial annual conference and book combination, CBHD’s 1997 annual conference was on the practice of healthcare: The Changing Face of Health Care: A Christian Appraisal of Managed Care, Resource Allocation, and Patient-Caregiver Relationships. Again, Dr. Orr provided the guiding light. In typically creative fashion, he titled his plenary address (and book chapter for the following year’s book on this theme) “Hippocrates Meets Managed Care: A Study of Contemporary Oath-Taking.”[4] It masterfully presents his extensive research into the oaths that doctors have taken through the centuries, noting how changing cultural values have changed the practice of medicine. Reflecting his extensive knowledge of healthcare practice, he served as co-editor of the entire book, which again adopted the same title as the conference.

In his medical practice, Dr. Orr had special opportunity to take care of older patients, and thus to reflect on the ethical challenges they experience—and present to society. When the Center designed the 2001 conference, Aging, Death, and the Quest for Immortality, there was no question that Dr. Orr would have plenty to offer. In fact, Dr. Orr ended up serving as co-editor of the following year’s book by the same title. His conference address (and, later, book chapter), “Does Gray Hair Cause Gray Answers? Ethical Issues in an Aging Population,” probed right to the heart of the conference theme.[5] Characteristically, it began with a clinical case that illustrated so well the issues that needed to be tackled.

While the two book series of CBHD noted above were written to discuss bioethical challenges at an academically and professionally rigorous level, CBHD has also produced many resources that translate such discussions into simpler language to make them more widely accessible. One good example of that is its BioBasics short paperback series. Each book in that series provides answers to several dozen key questions about a different bioethical issue, written in its entirety by an interdisciplinary team of about half a dozen leaders. Needless to say, Dr. Orr was a central figure on the team that wrote the 2004 volume entitled Basic Questions on Healthcare: What Should Good Care Include?[6] His hand is evident from the book’s appendix—the “Hippocratic Oath”—for him the bedrock of good healthcare.

Later, Dr. Orr made an important contribution to a book of a different sort, based on his faculty role as the clinical ethics professor at Trinity International University. From the early years of TIU’s Master’s degree in Bioethics program, he taught the Clinical Issues in Bioethics course required of every graduate of the program. Quite a few of his students went on to doctoral and other studies in clinical ethics—inspired to become clinical ethicists like their professor Dr. Orr.

In 2010 the faculties of Trinity Evangelical Divinity School and Trinity Graduate School carried out an extraordinary initiative to demonstrate, through a book, how the various disciplines of a divinity school and graduate school can equip the church to understand and engage tough bioethical challenges. An interdisciplinary team from various departments developed three rich case studies—one involving having a baby, one involving enhancing people’s brains, and one involving end-of-life healthcare. Next, in each department, all of the members worked together to marshal all that their discipline could offer to help people handle one of the case study situations well. The end-of-life case showcased how the field of medicine could most effectively work hand in hand with other disciplines to bless the church. Needless to say, Dr. Orr played a central role in authoring that chapter.

In a way, Dr. Orr’s contribution to this 2011 book—Why the Church Needs Bioethics: A Guide to Wise Engagement with Life’s Challenges—was a natural companion to his epic 2009 case study book, Medical Ethics and the Faith Factor. Both writings demonstrated, in different ways, that so many bioethical challenges require the kind of medical and theological understanding that skilled bioethicists can help make accessible to the church and to the world.

For Dr. Orr, “the world” was truly global in scope. He was sensitive to the ways that culture and race influence what good healthcare looks like, long before that became a topic of widespread interest. He recognized, for instance, that to equip students well through Trinity Graduate School’s bioethics initiatives in India, China, and Africa, his clinical ethics courses and contributions to the CBHD annual conferences had to be tailored to people’s settings and issues. Student evaluations consistently praised him for such tailoring.

When Dr. Orr signed my copy of Medical Ethics and the Faith Factor, he not only signed his name—he added a reference to the biblical verse Micah 6:8: “What does the Lord require of you? To act justly and to love mercy and to walk humbly with your God.” All three of those requirements were trademarks of Robert Orr. His legacy of theologically rich clinical ethics continues to be a great blessing to CBHD—and through CBHD, to the church and world.

References

[1] Robert D. Orr, Medical Ethic and the Faith Factor: A Handbook for Clergy and Health-Care Professionals (Eerdmans, 2009).

[2] John Kilner, Nigel M. de S. Cameron, and David Schiedermayer, eds. Bioethics and the Future of Medicine: A Christian Appraisal (Eerdmans, 1995).

[3] Robert D. Orr, “Christian and Secular Decision-Making in Clinical Ethics,” in Bioethics and the Future of Medicine, ed. Kilner, Cameron, and Schiedermayer, 138–52.

[4] Robert D. Orr, “Hippocrates Meets Managed Care: A Study of Contemporary Oath-Taking,” in The Changing Face of Health Care: A Christian Appraisal of Managed Care, Resource Allocation, and Patient-Caregiver Relationships, ed. John Kilner, Robert Orr, and Judith Allen Shelly (Eerdmans, 1998), 162–71.

[5] Robert D. Orr, “Does Gray Hair Cause Gray Answers: Ethical Issues in an Aging Population,” in Aging, Death, and the Quest for Immortality, ed. C. Ben Mitchell, Robert Orr, and Susan Salladay (Eerdmans, 2004), 45–57.

[6] Dónal P. O’Mathúna, Samuel D. Hensley, Mary B. Adam, John F. Kilner, Robert D. Orr, and Gary P. Stewart, Basic Questions on Healthcare: What Should Good Care Include? (Kregel, 2004).

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