Whether he sensed that a tempest was coming or only found himself traveling quiet lanes of thought that merged into a major highway of public debate, Dr. Andre Hellegers was better prepared than nearly anyone to discuss the links between religion, ethics and medicine.
At his death earlier this week, in The Netherlands where he was born, Dr. Hellegers, an obstetrician by training, had served for eight years as the director of the Joseph and Rose Kennedy Institute of Ethics at Georgetown University. He founded the organization at a time when few doctors, nurses or hospital administrators were publicly bestirring themselves to think beyond diseases and cures, much less to reflect on the ethical implications of their daily actions.
Under his direction, the institute grew from a few scholars to a staff of 100 that currently includes theologians, lawyers, physicians, nurses, historians and moralists. Attracted to it were students and scholars from Christian, Jewish and Islamic background. The result was a lively classroom atmosphere where judgments could be shaped about medical ethics and about the numberless grays between right and wrong.
As an intellectual, Dr. Hellegers thrived on the clash of ideas and showed particular skill in taking an obvious fact and showing that on second, third and fourth glances it was not so obvious after all.
I remember one conversation we had about cigarettes during which he, a smoker, declared that stock in tobacco companies was a sound investment. I offered my belief that the nicotine addict was socially irresponsible because he was raising the cost of the nonsmoker's health insurance. Maybe, he said, "but I am far from sure about it."
He went on to suggest as he did in a lecture in Brussels three days before he died, that so-called irresponsible behavior like smoking which creates costly health problems actually "depends on what laws exist and how the computer is programmed. If money produced or consumed is to be the unit by which equity and effectiveness in health care allocation is to be judged, then I might suggest we should strongly encourage all such patterns of behaviour as will kill us most closely to the day or our retirement.
"Under such a construct, smoking and heavy drinking might well be the most 'effective' behavior in cost-benefit terms. We shall have contributed the most dollars to the common economy and consumed none through retirement.
I don't believe he was buying that particular argument as much as he was insisting on his love of "thinking things through." He knew that in debates about ethics, the rational isn't the only force at work. He spoke of people who become unable to function in society because society's values give little room for natural infirmities.
"In the United States," he said in a lecture, "there are literally thousands of people with facial wrinkles, sagging breasts, behinds and noses not to their liking who undergo surgery every year to have their appearance changed-not because their tissues are diseased . . . but because they have to function in a society with a phobia about aging and with certain notions of beauty. It used to be that 'beauty is in the eyes of the beholder.' If we now consider absence of a beauty a disease, it becomes clear that 'disease is now in the eyes of the beholder.' What does that say about the function of medicine?"
In Washington, Dr. Hellegers came to be relied on by the media for opinions about the cases of medical ethics that are now part of the regular news beat.
As a moralist who steered clear of moralizing, he thought political debate on such issues as using Medicaid funds for abortions needed to be focused on human concerns.
During the arguments over the Hyde amendment, when economists came forward with cost projections for children not aborted as fetuses, Dr. Hellegers said it was chilling that "our children have become a line item in budgets. It seems clear that the children of the poor can never repay the nation for their birth except, perhaps, by laying down their lives in disproportionate numbers in times of war."
As a writer who produced steadily for both the obscure journals read by his fellow obstetricians as well as some of the national magazines, Dr. Hellegers had a contempt for those he believed were turning bioethics into a circus.
In a lengthy article last year in The Washington Post, he surgically dissected the best selling book "In His Image-The Cloning of A Man." After exposing the nonsense and the blunders of the author, David Rorvik, Dr. Hellegers said that the author "will earn a sizable sum by a hoax."
"He is not the first author to do so. But for me the puzzle is the publisher. In an unctious forewood to the book, Lippincott tells us it was impossible to authenticate Rorvik's story. Did it try, by submitting the manuscript to reputable scientists? Or did it limit itself to believing that Rorvik 'would treat these issues in a revealing, responsible manner,' as the foreword claims?
"In the final analysis this book is not just about a postulated clone or about Rorvik. It is also about the responsibilities of publishers."
Much of Dr. Hellegers' professional life came from his own philosphy of responsibility. He lamented that in the fever of medical technology the caring branches of medicine were being replaced by the curing ones. He thought that the "old virtues" of caring will soon come back, when "our patients will need a helping hand and not a helping knife."
Because he kept in touch with patients in the rooms and wards of the hospitals, he had a wary eye for the physician who gave light treatment to the moral rights of the sick.
"What are demanded right now," he said in 1974, "are a few law suits against doctors who persist in battering patients, in giving dying patients useless treatment. Patients do not belong to doctors. Doctors have no right of ownership. Consequently, doctors have no right to treat a patient against his will."
At his death at 52, Dr. Hellegers had proved that the work of a physician is compatible with the thinking of the metaphysician. He happened to be here when the country, leaving behind its naive faith that "doctor knows best," began to look to the ethicists for moral direction. We found it in him. CAPTION: Picture, DR. ANDRE HELLEGERS