Bioethics Forum Essay

Hastings, Botswana, and Edinburgh: Bioethics Meets Detective Fiction

In the bioethics world, all roads eventually lead to Hastings, whether that means the Center in Garrison, N.Y., or Hastings-on-Hudson, N.Y., where the Center was born in 1969 and lived for almost 20 years. The relationships among those who have worked at or visited Hastings make up a global network of scholars, clinicians, lawyers, researchers, writers, and others.

I realized the scope of that network recently when I began to read What W. H. Auden Can Do for You by Alexander McCall Smith, recommended by my friend Glenorchy. A loyal son of Clan Campbell and a devoted follower of all things Scottish, including the prolific writing of Mr. McCall Smith, Glen knew about my admiration for Auden’s poetry. He may not have known that I am one of the millions of readers who wait eagerly for McCall Smith’s newest book in the “No. 1 Ladies’ Detective Agency” series, set in Botswana. Mma Precious Ramotswe, the agency founder who takes cases that mostly deal with human frailties, is a refreshing antidote to grim Nordic noir and the mean streets of American detective fiction.

Mma Ramotswe is only one of Mr. McCall Smith’s intriguing fictional characters. The Sunday Philosophy Club series, set in Edinburgh, features Isabel Dalhousie, founder and editor of the Review of Applied Ethics. She is a moral philosopher with a tendency to immerse herself in other people’s mysteries.

I had reached page 30 of the Auden book, when, as the cliché has it, a sentence jumped out at me. Mr. McCall Smith wrote, “I remember my discovery of Somerset Maugham, whom I first read in my late twenties when I was spending a month at a research institute in Hastings-on-Hudson, New York.” I lived in Hastings-on-Hudson and I worked at the Center for several years; why didn’t I know that one of my favorite authors spent some time at the Center?

I sent an e-mail to Mr. McCall Smith in Edinburgh, inquiring whether indeed he had been at The Hastings Center and if he would be willing to answer a few questions about his stay there. While waiting for a response, I quickly learned that before Mr. McCall Smith became a full-time and very successful writer, he had been a distinguished professor of law and medicine at Edinburgh University and a well-known figure in British and European bioethics. He was the chairman of the British Medical Journal’s Ethics Committee, vice-chairman of the United Kingdom’s Human Genetics Commission and a former member of UNESCO’s International Bioethics Committee. Born in what is now Zimbabwe, he returned to southern Africa in 1981 to co-found and teach law at the University of Botswana. With Kwame Frimpong, he co-authored the only book on the country’s legal system, The Criminal Law of Botswana.

So it wasn’t so surprising after all that at an early stage of his academic career, Mr. McCall Smith would have spent a month at Hastings. Nor is it so surprising, given his success as a fiction writer, that he would have remembered discovering Somerset Maugham, another noted storyteller.

Mr. McCall Smith wrote back and confirmed that indeed he had spent a month in 1979 at the Center. He remembered Will Gaylin, Bob Veatch, and Dan Callahan, and how courteous and helpful everyone was during his stay. “I spent a lot of time in the library exploring a whole range of issues, but I was at that time particularly interested in reading about the concept of human dignity.  That resulted in a small publication in the Journal of Medical Ethics.”  The article he wrote is “Dignity and Medical Procedures,” published in June 1981. Though written more than 30 years ago, Mr. McCall Smith identified currently worrisome trends to equate dignity with perfection, especially in genetics and extreme treatments at the end of life.

Although Mr. McCall Smith has retired from the academic and policy worlds of bioethics and law, hints of his earlier career turn up in his fiction, especially the Isabel Dalhousie series. In The Comforts of a Muddy Saturday, for example, she investigates a case in which a doctor loses his position because of allegations of research fraud in developing a new life-saving drug. But Isabel goes far beyond strictly medical issues and often analyzes ordinary events in an ethical context. Not surprisingly, she is as likely to quote Auden as Kant.

In my e-mail I asked Mr. McCall Smith about the differences between Precious Ramotswe and Isabel Dalhousie.  He replied,”Mma Ramotswe, as you point out, is very different. Her wisdom is common-sense based and she approaches matters from a very different angle than that which is adopted by Isabel Dalhousie.  I think Mma Ramotswe relies a lot on moral intuition; Isabel would take a more structured and formal approach.  Mma Ramotswe almost always gets it right. Isabel Dalhousie sometimes gets it very wrong!”

Finally, I asked whether some case with a bioethics twist might turn up in Mma Ramotswe’s agency. He replied, “I don’t think that a bioethical issue would turn up in Mma Ramotswe’s life, although now that you have suggested it, that may change!” If that happens, I am sure the story will be told with Mr. McCall Smith’s characteristic charm, insight, and dignity.

Photo: City  of Edinburgh Council: Tony Marsh, Photographer

Carol Levine directs the Families and Health Care Project at the United Hospital Fund in New York.  She is a Fellow of the Hastings Center and a former editor of the Hastings Center Report.