John C. Fletcher, 72, an iconoclastic former Episcopal priest who became a leading biomedical ethicist, studying the practical application of ethics in hospital care and medical research, died May 27 at his home in Keswick, Va., near Charlottesville.
A spokeswoman for the Virginia medical examiner's office said Dr. Fletcher drowned, and the death was ruled a suicide. Caldwell Fletcher said his father suffered from clinical depression.
At his death, Dr. Fletcher was professor emeritus of biomedical ethics in internal medicine at the University of Virginia medical school. Earlier, he had been the chief ethics officer of the National Institutes of Health's Clinical Center and founder of a nontraditional center to prepare clergy for their calling.
At once deeply religious and highly skeptical -- he renounced his ordination in the mid-1990s as a matter of what he considered intellectual honesty -- Dr. Fletcher had emphasized rigorous functional experience for future clergymen. He felt seminaries were too classroom-based and did not give students an up-close view of the shades of anguish and politics that pervade congregation life -- factors he said led to deeper self-reflection of the calling.
The same philosophy girded his work as a bioethicist. Arthur L. Caplan, a chairman of the medical ethics department at the University of Pennsylvania's medical school, called Dr. Fletcher a mentor and a pioneer of clinical bioethics, "trying to teach and train people to go to bedsides and work in real time with real patients and families."
As a lecturer and prolific author, Dr. Fletcher inserted himself into the nexus of science and spirituality and was a prominent authority on the moral debates that arose. Before scientific and congressional panels, he spoke out about abortion, surrogate motherhood, hospital ethics committees, developments in genetic engineering, human stem cell research and technological advancements that allow the early detection of genetic illness.
He once voiced objection to the "commercial aspect" of surrogate motherhood, the selling of one's body to have a child. He likened the transaction to selling a kidney or heart to a person who needs a transplant.
"We've adapted technology under the older concept of gifts," he told The Washington Post in 1983. "We use the obligation of gift, rather than an economic transaction -- both to prevent poor and needy people from mutilating themselves and to prevent their exploitation.
"I think we have to take action to de-commercialize surrogacy and prevent not only exploitation, but particularly the abandonment of unwanted children."
Coursing through the issues were the human elements, the emotions of fear and ignorance that can rule how people treat each other.
He had counseled a young man who carried the recessive gene for Tay-Sachs disease, a hereditary disorder that is always fatal to infants, but refused to tell his fiancee about the problem. A single mother, estranged from her husband, debated telling their children about the former spouse's medical history, even though it included a genetic disorder that posed great risks to them and their offspring.
Dr. Fletcher said physicians and spiritual advisers complemented each other's abilities when it came to human frailties. But he added that physicians too often viewed death as an enemy to be combated at all costs.
"Doctors don't have to bear these burdens alone," he told The Post. "And the temptation to bear them alone is a temptation to omnipotence. If a physician succumbs to that, the physician might make moral judgments and ethical judgments on behalf of others without letting the patient and the family bear their due responsibility."
John Caldwell Fletcher was born in Bryan, Tex., and raised in Birmingham. His father was an Episcopal priest who traveled in the South to perform missionary and counseling work for the deaf.
He was an English literature graduate of Sewanee: the University of the South and received a master's degree in divinity from Virginia Theological Seminary in Alexandria. From 1956 to 1957, he was a Fulbright scholar at the University of Heidelberg and later received a doctorate in Christian ethics from Union Theological Seminary in New York.
Dr. Fletcher served as chaplain of Washington and Lee University in Lexington, Va., and Midtown Medical Center in New York before settling in the Washington area in 1966.
He became associate professor of church and society at Virginia Theological Seminary. Dissatisfied with conventional religious education, he started Interfaith Metropolitan Theological Education Inc., known as Inter/met, in 1971.
Over the next six years, he built a small, sprightly student body from a blend of races, sexes and religious convictions. The center lacked a formal campus, but it did not matter; students spent 24 to 40 hours a week serving apprenticeships in Washington area houses of worship and then analyzed what they had seen.
The Rev. James R. Adams, former rector at St. Mark's Episcopal Church in Washington, where Dr. Fletcher was an adjunct cleric, said Dr. Fletcher "felt people were not adequately prepared for work in congregations.
"Fieldwork amounted to 12 hours a week, including travel time, and the students were never thoroughly immersed in the life and leadership of a congregation," Adams said. "It was his opinion that their role models tend to be their professors, and their professors are people who decided to do something other than parish ministry."
A constant financial strain and the economic recession forced Inter/met to close in 1977, which Adams called a great disappointment in Dr. Fletcher's life.
He went on to be named the first formal chief of the bioethics program at the NIH Clinical Center before joining the University of Virginia faculty in 1987.
Dr. Fletcher wrote hundreds of articles, and his books included "Coping With Genetic Disorders: a Guide for Clergy and Parents" (1982) and "Ethics and Human Genetics: A Cross-Cultural Perspective" (1989), a text edited with sociologist Dorothy C. Wertz that surveyed medical geneticists worldwide.
In 2001, the American Society for Bioethics and Humanities awarded Dr. Fletcher its lifetime achievement award.
Besides Caldwell Fletcher of Houston, survivors include Dr. Fletcher's wife, Adele Woodall "Dale" Fletcher of Keswick, whom he married in 1954; two other children, Dr. Page Fletcher of Hillsboro and Dr. Adele Fletcher Mays of Knoxville, Tenn.; two sisters, Roberta Ray of Mathews, Va., and Louise Fletcher of Los Angeles, who won an Academy Award for playing Nurse Ratched in the film "One Flew Over the Cuckoo's Nest"; and six grandchildren.
Dr. Fletcher struggled with his own religious convictions and in the mid-1990s renounced his Episcopal ordination, although he continued to attend various church services.
"I am probably too heterodox in my religious beliefs to succeed full time in the ministry, but I see myself as a loyal member of the Protestant persuasion of the Episcopal Church," he once told Contemporary Authors, a biographical guide to writers. "I abhor intellectual dishonesty and the shallowness of most thinking and action in religious circles, but I will not put the need to be ultimately accountable aside, because I know that it is a genuine human need."