by Robert Macauley MD
Next to “Clinical Ethicist” in the dictionary, there really ought to be a photo of Bob Orr. Not only was he at the forefront of what was then a nascent field, his writing, teaching, and mentoring influenced and molded the next generation of clinical ethicists.
After completing a postdoctoral fellowship at the Maclean Center for Clinical Medical Ethics at the University of Chicago in 1990—back when that was one of the few such training programs in existence—he went on to start the clinical ethics program at Loma Linda University Medical Center, before returning to his adopted home state to start the Department of Clinical Ethics at the University of Vermont, too. He held the rank of full Professor at both institutions, as well as at Trinity International University and Union University Graduate School, where he taught bioethics for many years. In addition to his faculty appointments, he lectured widely throughout the United States, as well as over 20 foreign countries. He was also an accomplished scholar, authoring/co-authoring/editing six books (including Medical Ethics and the Faith Factor, 2009), 15 book chapters, and over 150 academic articles.
His former students—and, increasingly, their former students—broadly populate the field of clinical ethics. A consummate teacher, Dr. Orr took the word “clinical” in his job title literally, making a point of always going to the bedside and meeting face-to-face with the most important person involved in the consult: the patient. He also made a point to regularly follow up with the patient and family as well as the medical team, in order to provide ongoing support and incorporate the lessons learned from prior consultations into his subsequent work.
He eschewed verbose theoretical analysis in favor of the Aristotelian concept of phronesis, or practical wisdom. An ethics consultation, he would often say, needs to be relevant and helpful, especially to the medical professionals who sought guidance from it. That’s one of the reasons that he expected consultations to be no more than two typed pages (at least back in the days before the electronic medical record made “pages” an obsolete measure). “If you can’t say it in two pages,” he would sometimes remark, “then you don’t know what you’re saying.” Yet, he wouldn’t challenge the narrowed margins and condensed fonts that some of his mentees—including yours truly—sometimes resorted to in an attempt to squeeze in one more nuance of an argument.
As a mentor, he was incredibly generous in spirit, devoting countless hours to offering feedback and guidance to learners of all levels. He was always ready to listen to someone who called with a question or a need, and only then would he share profound wisdom with deep humility. This applied not only to friends and colleagues, but also to strangers, as I can personally attest.
Almost exactly twenty years ago, my fiancée and I planned a kayak camping trip along the rural rivers of Vermont, where we hoped to settle down. Fortuitously for us, there happened to be a prolonged drought that summer, forcing us to ditch the kayak in favor of a B&B, where I stumbled across an op-ed in the local paper (which I’d never read before) written by someone named Bob Orr (whom I’d never heard of) who worked as a “clinical ethicist” (which I’d also never heard of). Upon returning to New York City, I wrote him a letter out of the blue, ostensibly expressing curiosity about his work while not-so-subtly angling for a job. In typical Bob Orr fashion, he invited me to come (back) up to Vermont for a visit, and went on to offer me a chance to try my hand at clinical ethics, to see if it was a good fit. It turned out to be, in ways that fundamentally changed my life. Along the way, he became Grandbob—and his wife “Grandma Joyce”—to my four kids, and a second father to me.
Those who knew him as a world-renowned clinical ethicist might be surprised to learn that that was his second career, following nearly two decades as a quintessential “country doctor” in small-town Vermont, where he cared for his patients from birth to death: delivering babies (sometimes two-at-a-time, and sometimes remotely when a pregnant woman didn’t have time to make it to the hospital), diagnosing serious illnesses, and ensuring comfort and dignity at the end of life. Time and again he went above and beyond the call of duty, including once when a decompensating patient refused to go to the “big city hospital”—a.k.a. Dartmouth-Hitchcock Medical Center—with unkempt hair, so Bob dug up his old barber scissors (which he’d used to cut his own hair, back when he was a poor college student) and gave the patient a trim at the community hospital, before wheeling the stretcher into the ambulance for transfer.
Bob received a plethora of well-deserved awards, including Who’s Who in American Universities & Colleges (Houghton); Alpha Omega Alpha Honorary Medical Society (McGill); University Scholar (McGill); Vermont Family Doctor of the Year (1989); the American Medical Association’s Isaac Hayes and John Bell Award for Leadership in Medical Ethics and Professionalism (1999); Who’s Who in America; Scholar in Residence at the historic home of C.S. Lewis (Oxford, England, 2006); the Servant of Christ Award (Christian Medical and Dental Associations, 2009); and several teaching awards from various academic institutions. His legacy in medical ethics will be remembered through the Robert D. Orr Endowed Fellowship at the Center for Bioethics and Human Dignity (Deerfield, IL), the Endowed Lectureship in Medical Ethics of the Christian Medical and Dental Associations (Bristol, TN), and the annual Robert Orr Lecture in Medical Ethics at the University of Vermont Medical Center, but mostly through the ongoing work of his many students who have earned their own accolades in the field of medical ethics.
Bob didn’t just “talk the talk”; he lived out the principles he espoused, right to the very end. When immunotherapy stopped working, he knew he was going to die from his cancer. Yet he continued to write his much beloved “News from Vermont” newsletters, where he kept friends and family apprised of how he was doing while sprinkling in quirky facts about the Green Mountain State, which I learned holds the world record for tallest filing cabinet (with 38 drawers) and largest s’more (343 pounds). His last missive was called “The Final Chapter” and arrived soon after Easter, where he said it wouldn’t be long now and also that “Jesus went to prepare a place for us and I am going to check on the dusting.” (A man of deep and abiding Christian belief, Bob approached his personal and professional life through the lens of faith.)
After companioning so many patients—both as a family doctor and a clinical ethicist—through their final days, Bob approached his own with immense courage and dignity. He told the people he loved how he felt about them—including his wife of 59 years, who he said was about to become “the most beautiful widow in Burlington”—and did all he could to care for them to the very end, including planning his own memorial service, right down to the last detail.
I had the privilege of spending a weekend with him, not long before he died, along with my eighteen-year-old daughter, Catie, who as a preschooler used to spend every Friday with Bob and Joyce. Together with Bob’s family, we all ate his favorite foods and recalled treasured memories, even as he spent more time in his favorite recliner, alternately dozing and gazing out on Lake Champlain.
“I think it’s time,” he said with moist eyes, as our flight back to the West Coast grew close. As usual with Bob, words meant many things, both practical and profound. We hugged and cried and said goodbye, for what we all knew would be the last time we saw each other.
As Catie and I walked down the snow-covered sidewalk to our car, tears streaming down our faces, I reflected that she would probably accompany many people down a similar path, over the course of her life.
“But,” I said, “you will never—ever—see anyone do it with more courage or grace than your Grandbob.”