After a career spanning half a century, Dr. John Dossetor is staking out new territory as CMAJ's ethicist and ombudsman. They are the first appointments of their type for a Canadian scientific publication (see p. 1281).
Dossetor is no stranger to innovation — he coordinated Canada's first kidney transplant in 1958 and later headed one of the country's first bioethics departments. An India-born Oxford graduate (1950), he arrived at McGill in 1955 after completing 2 years of National Service and a residency in general internal medicine. After obtaining the MRCP(UK) in 1955, he was offered a teaching fellowship at McGill. Despite the paltry pay of $200 a month he leapt at the chance — the fact his wife-to-be had just moved to New York City, a short train trip from Montreal, added to the job's attractiveness. After completing the fellowship and spending a year as chief medical resident, he decided it was time to specialize, and McGill suggested nephrology. At the time, there were about 4 nephrologists in the entire country.
Within a year, he was coordinating the first kidney transplant in the Commonwealth (there had already been 5 in Boston). It involved 15-year-old, identical-twin sisters; the recipient lived another 25 years, and Dossetor is still friends with the donor.
By 1963 he was director of renal and urologic research at the Royal Victoria Hospital, and for the next 6 years he oversaw Canada's first cadaver kidney transplant program, which in the mid-'60s was second largest in the world. The survival rates weren't impressive, but Dossetor says the major ethical question involved the use of cadaveric organs. “Most people thought this was repugnant,” he recalls.
But there were no ethics committees then. “Everyone has stories about things they did, which sound horrendous now. At the time they said they were in the patient's best interest, but we'd probably never do them now.”
Dossetor's research concentrated on the immunologic aspects of renal transplantation, and in 1968 he was appointed a career investigator by the Medical Research Council of Canada. A year later, the council convinced him that he couldn't be both a “king” clinician and researcher; he chose research, and the University of Alberta asked him to expand the immunology aspects of its nephrology program. As director of the division he taught, and as codirector of a research group he did research on immunogenetics and immunologic monitoring of transplant recipients.
He grew increasingly concerned about the escalating number of ethical dilemmas arising because of advances in medicine. Truly informed consent — “comprehended choice” — took on new importance. He also started facing new ethical quandaries in his own practice — one of his patients found someone willing to sell a kidney for transplant. “It made me think that bioethics was becoming an increasingly important field.”
In 1985 he changed paths and spent a year studying medical ethics, and a year later was named director of the University of Alberta's new Joint-Faculties Bioethics Project, which eventually evolved into the John Dossetor Health Ethics Centre.
Dossetor, who retired to Ottawa in 1998, says his biggest challenge at CMAJ will be “to be relevant and useful, not just another talking head.”
But he cautions readers against expecting clear-cut solutions to issues they raise. “Ethics is not about answers. Ethics is about asking more questions.” — Barbara Sibbald, CMAJ
Figure. Dr. John Dossetor: No stranger to innovation Photo by: Barbara Sibbald