Healthcare Ethics, Law and Professionalism

Essays on the Works of Alastair V. Campbell

Voo Teck Chuan, Richard Huxtable, Nicola Peart, Voo Teck Chuan, Richard Huxtable, Nicola Peart

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351669504
• Edition: 1
• Topic: Law
• Subtopic: Law Theory & Practice
• Index: Law

Healthcare Ethics, Law and Professionalism: Essays on the Works of Alastair V. Campbell features 15 original essays on bioethics, and healthcare ethics specifically. The volume is in honour of Professor Alastair V. Campbell, who was the founding editor of the internationally renowned Journal of Medical Ethics, and the founding director of three internationally leading centres in bioethics, in Otago, New Zealand, Bristol, UK, and Singapore.

Campbell was trained in theology and philosophy and throughout his career worked with colleagues from various disciplines, including law and various branches of healthcare. The diversity of topics and depth of contributors' insights reflect the breadth and impact of Campbell's philosophical work and policy contributions to healthcare ethics. Throughout his long academic career, Campbell's emphasis on healthcare ethics being practice-oriented, yet driven by critical reflection, has shaped the field in vital ways.

The chapters are authored by leading scholars in healthcare ethics and law. Directly engaging with Campbell's work and influence, the essays discuss essential questions in healthcare ethics relating to its methodology and teaching, its intersection with law and policy, medical professionalism, religion, and its translation in different cultural settings. Chapters also grapple with specific enduring topics, such as the doctor-patient relationship, justice in health and biomedical research, and treatment of the human body and the dead.

Part I

Introductions

Alastair Vincent Campbell

Scholar, teacher, advocate, leader, friend and colleague

Thomas H. Murray

The first time I met Professor John Eu-Li Wong, he informed me that he had obtained funding to create a Chair in Biomedical Ethics. My task, he explained, was to find the person who would be the initial holder of that chair and the director of a new centre at the Yong Loo Lin School of Medicine at the National University of Singapore. I was taken aback, to say the least. But John was so earnest and persuasive that I agreed immediately to do what I could to help him find the ideal candidate for this important post. John had a clear vision of the qualifications he sought, among them that the individual should be both an international leader in the field and a physician.

I added another criterion: The person should be a builder – that is, someone who understood what was required to create a thriving programme, able to recruit very promising junior colleagues and to nurture their development.

I cannot recall all the names we discussed but it soon became clear to me that restricting the search exclusively to physicians narrowed the pool excessively and, in my view, needlessly. Many fine programmes had been created under the leadership of physicians. But so had many other excellent ones by non-physicians, including programmes at leading medical schools. Would he consider candidates who were outstanding in all respects but not physicians? John agreed.

I had no one particular in mind when I made this suggestion. But, as happens on occasion, I woke in the middle of the night with an epiphany. I knew exactly the right candidate: An internationally renowned scholar who had built not one but two outstanding programmes, with all the intellectual, social and political skills needed to create an excellent programme at the National University of Singapore. There were additional factors in his favor: He was about to step down from the leadership of his current centre at the University of Bristol; and, I happened to know, he and his partner were adventurous, not at all intimidated by the prospect of learning to navigate a new culture and new institutions.

I immediately contacted John and suggested I introduce him and Alastair V. Campbell to each other via email. He agreed and you know more or less what followed. My recollection is that things moved swiftly from there (at least by the usual standards at the National University of Singapore). Alastair became the first Chen Su Lan Centennial Professor and the Centre for Biomedical Ethics was born.

Alastair’s colleagues at Bristol had celebrated the completion of his tenure as programme head with a day-long symposium – a series of challenging scholarly papers, one relentlessly following another. They slotted my presentation as the very last on that long day. To me this meant two things. First, the audience was likely to be weary. No matter how stimulating the papers, a full day of paper after academic paper would wear out most human beings. Second, however scrupulously the session chairs tried to keep on schedule, by the time my presentation began we would be running out of time and people would be eager to call it a day. I wanted to do something that would be warm, humorous, on target, and quick. Fortunately, Alastair’s wife, Sally, and my wife, Cynthia, agreed to be co-conspirators, which required them to find somewhere in Bristol just the right item of clothing. To be precise, a hat. Not just any hat, a wizard’s hat. The premise of my presentation that afternoon was that no normal human being could have accomplished what Alastair had done and, therefore, we needed to look for an alternative explanation. Which I was delighted to provide: Alastair, I explained, was in fact the great wizard and head of Hogwarts School, Albus Dumbledore, in disguise. As proof, I showed photos of Dumbledore and Alastair side by side. In any event, once we placed the wizard’s hat on his head, the identification was indisputable.

That hat followed Alastair to Singapore, Even if you have not seen it in his office, indisputable proof exists that his wizarding power was undiminished: The Centre for Biomedical Ethics’s astonishingly rapid growth from a gleam in John Wong’s eye to a potent international force in Bioethics, a major mover in the School of Medicine, and a valuable source of ethics support for the government of Singapore. Of course, the Centre’s success cannot be attributed to any one person. It required many people’s vision, support, collaboration and dedication. But it is also true that the success of any institution or programme depends heavily on the skill, integrity, wisdom and work ethic of the individual who leads it. In Alastair, the National University of Singapore chose well. Of course, if the best predictor of future success is a track record of past successes, it was not much of a gamble. If there is another prominent Bioethicist who has founded three successful centres, I am not aware of who that might be. Alastair could be described, I suppose, as a serial founder.

One way to understand how Alastair has been able to accomplish so much is to consider key roles he has filled in his distinguished career: as thinker; as teacher; as engaged in critical policy debates; as leader; and as friend and colleague. The account that follows is indebted to Alastair’s former colleagues Nicola Peart and Richard Ashcroft, his current colleague Voo Teck Chuan, his partner in life Sally Campbell, and my recollections of our time together.

Thinker

When I first began writing as a scholar I was thrilled to be published. Later I wanted whatever I had published to be read. Finally, I realised that what was ultimately important was to participate in significant public conversations – that is, to publish, to be read and (at least mostly) understood, and to have a constructive impact on how we think about and act towards matters of great importance. By any and all of these criteria, Alastair has had an altogether worthwhile career as thinker and scholar. According to Google Scholar, his work has been cited well over 2,000 times by other scholars. It ranges broadly from pastoral and professional care to a host of important issues in medical ethics and medical education. His recent book, The Body in Bioethics, is a revealing extended meditation on the human body’s significance in life and, hence, in Bioethics. Through his reflections on the meaning of donated versus purchased organs for transplantation, cosmetic surgeries, the ‘Body World’ displays of plasticised human corpses and controversies over the repatriation of ancient human remains, Alastair shows the moral myopia that can follow from a naive embrace of Cartesian dualism, from which comes the belief that our minds and bodies are fully separate and distinct entities. The Body in Bioethics is an extended argument for the view that:

we remain what we inevitably are – vulnerable living tissue, located in time and space. Our bodies and the bodies of our fellow humans are always with us, an inescapable concomitant of being living, conscious beings. If we ignore this aspect of human life, we will end up with an abstract, theoretical and ultimately irrelevant bioethics.¹

I should add that this moral myopia also leaves us vulnerable to transhumanist fantasies of disembodied consciousness uploaded onto immortal computers, and makes it difficult to understand what is at stake when, for example, we pump athletes full of anabolic steroids and other performance-enhancing drugs.² Appreciating what it means to be an embodied, conscious, reflective creature goes a long way toward enriching our understanding of many controversies in Bioethics.

Teacher

Alastair’s decades of wrestling with complex moral and practical problems in medical ethics served the National University of Singapore well when he arrived and began sharing what he had learned. His philosophically trained colleagues, in some cases, took a while to appreciate fully his practical wisdom, as Voo Teck Chuan describes:

In the early days of CBmE [the Centre for Biomedical Ethics], Alastair was giving talks to the healthcare community on medical ethics so as to publicise CBmE and the nature of ethics teaching. Jacqueline Chin (then Research Fellow) and I (then Research Assistant) were roped in to help with the research based on an earlier talk he gave in the UK. Alastair said it would be a case of cauld kail het up, a Scottish phrase which he explained as ‘reheating and serving leftover cabbage’, so we should just update his slides with the latest relevant literature rather than look for fresh arguments. At that point in time, I read the phrase as essentially pejorative. As a philosophically trained, junior researcher, I thought all academic work should focus on ‘originality’, whatever this means. It is only in 2017 – the 10th year anniversary of CBmE – that I realised there is certain wisdom, in that context, to using ‘leftover cabbage’. I found out recently that figuratively, ‘cauld kail het up’ may be interpreted as reviving an old tale. It was serving up accumulated years of insight and reflection on the subject matter and considering their relevance against the backdrop of advancements in medical ethics and medical ethics education. The talk was transcribed and published with the title ‘How can we know that ethics education produces ethical doctors?’³, co-authored by the three of us, a well-respected bioethicist and two philosophers transitioning to the field. The article highlights the limits of ethics education – for all the effort tutors put in, we cannot know for sure that a student will turn out to be an ethical doctor. But it also urges the need for academic rigour in teaching and assessment, with the concept of a ‘reflective practitioner’ as an ideal we guide students toward. Despite changes in topics and teaching methods, this remains the key approach of our undergraduate longitudinal Health Ethics, Law and Professionalism (HeLP) curriculum.

Under Alastair’s leadership, admirably comprehensive educational programmes for people training in medicine, other health professions, as well as advanced degrees in Bioethics were organised at Otago University in New Zealand, the University of Bristol in the UK and the National University of Singapore.

Engaged public actor

In their insightful essay in this volume, ‘Healthcare Ethics in New Zealand’, Lynley Anderson and Nicola Peart describe in detail the crucial role Alastair played in helping the citizens of New Zealand come to terms with the revelations of unethical research performed on women with carcinoma in situ. The investigation that followed, known as the ‘Cartwright Inquiry’ after the distinguished judge who chaired it, rattled the faith of New Zealanders in their physicians and scientists and unsettled those professions.

Alastair’s contributions to the Inquiry helped to set medicine and science on a sounder ethical basis and instituted a new norm for who should have a voice in approving research. Among the reforms he championed, the committees reviewing research protocols with human subjects were reconstituted. They were now required to have equal numbers of lay and professional members, and the chair was to be chosen from among the lay members. (My two visits to New Zealand were both to teach in summer workshops aimed specifically at those lay committee participants. I found the people I met to be thoughtful and serious about their responsibilities.)

Peart describes the broad and lasting impact of Alastair’s leadership:

Alastair developed the Bioethics Centre into a centre of national significance. Its advice was sought from around the country and its influence nationally was significant. It was a time of great change and Alastair played a key role in that change. His success was largely due to his ability to bridge diverging views, to find compromise and to help health professionals deal with ethical issues in a constructive and unpatronizing manner.

Alastair found many more ways to contribute to public deliberation and public policy in New Zealand, as he did in his subsequent roles. In the UK, he served as Chair of the Ethics and Governance Council of UK Biobank, and as Vice-Chair of the Retained Organs Commission. In Singapore, he served as an adviser to the Ministry of Health. Taking seriously his work as thinker and as teacher, Alastair recognises an obligation to participate in the world outside the academy. When one’s scholarship makes it clear that the human subjects of research must be fully respected and their informed consent provided, public advocacy for that respect follows closely. If one’s scholarship leads to strong conclusions about the nature of a just healthcare system, then one should grasp opportunities to press for justice in one’s own system. If your investigations reveal that markets in human organs for transplantation exploit the poor and that better alternatives exist, then, as Alastair has done, argue on behalf of those alternatives.

Policy is driven by many forces and competing interests. You will not win every argument, and what you win today may be undone tomorrow. But those are not reasons to give up the fight. Alastair continues to advocate for what he believes is right and good. One way to keep up the good fight is to seed institutions that can nurture others able and willing to join in the effort, and that he has done with great success.

Leader

For all that he has accomplished as thinker, teacher and engaged public actor, there is a powerful argument to be made that Alastair’s successes as leader and founder of multiple institutions may be the most remarkable of all. He was the founding editor of one of the most prominent journals in the field, the Journal of Medical Ethics. He played a key role in organising the International Association of Bioethics. And, of course, he was essential to the growth and success of three different centres of excellence in Bioethics – Otago, Bristol and Singapore. Richard Ashcroft, Alastair’s former colleague at Bristol, describes what a good leader does:

I first met Alastair when I applied for the role of Lecturer in Ethics in Medicine, to join him in the newly founded Centre for Ethics in Medicine. Alastair and Sally welcomed me into their home before I took up the job, so I could get to know Bristol and the University before I got started. That set the tone for our whole working relationship. Alastair and Sally took a warm interest in me, as with all the staff and students who joined the Centre under Alastair’s Directorship. He helped me find a home in Bristol, he got me started, he introduced me to all sorts of interesting people, he gave me chances.

Alastair believed in hard work, but also in work-life balance and in good fellowship. It was important to be able to have fun and relax, as well as to put in long hours when necessary. He was understanding when personal difficulties or illness made working difficult or impossible, and he is a wonderful listener. But equally he would brook no nonsense in terms of unprofessional behaviour, rudeness or sloppy work. He set the tone. I have now been working in higher education for more than 20 years, but I have never had a boss who was a true leader like Alastair. You want to please and impress him. You do not want to let him down.

He brings out the best in people, and he gives people lots of opportunities which might otherwise not come their way. I got invaluable experience representing the Centre in committee work, in course development, in making speeches on professional occasions, in leading research projects and in publication whic...

Table of contents

• Cover
• Half Title
• Series Information
• Title Page
• Copyright Page
• Frontispiece
• Contents
• List of Contributors
• Dedication and acknowledgements
• Part I Introductions
• Part II Healthcare ethics in theory
• Part III Healthcare ethics in disciplinary contexts
• Part IV Healthcare ethics in cultural contexts
• Part V Healthcare ethics education
• Part VI Health-related practices in ethical focus
• Index