by Trudo Lemmens, Lic. Jur., L.L.M. (Bioethics) Biomedical Ethics Unit, McGill University

enjy had this incredible physical presence. Everyone knew when he was in the room." This is how Alan Freedman described his brother, Benjamin Freedman, at his funeral on March 21, 1997. All of those who had the honour of knowing Benjy Freedman understood this description, which encompassed his entire person: his physique, his charismatic voice, his wit, his solid intellect and his critical mind. His persona seemed at times to fill a room. In discussions, people would focus on him and his body language. Nervous movements or mumbling indicated that he really felt challenged and that an intellectual battle was about to start. Many admired and were charmed by his personality, while others could not get used to his direct, uncompromising style. But no one could deny respect for what he accomplished in his all-too-short life as a devoted husband and father, a committed community man and Orthodox Jew, a teacher, researcher and clinical ethicist.

When Dr. Freedman died on March 20 at the age of 45 from complications after palliative surgery for a gastric cancer, he left over 120 articles and six books as an enduring legacy to the Canadian and international world of bioethics. Freedman wrote most of his work after arriving in Canada in 1979 with a doctorate in philosophy from the City University of New York and after an appointment at the Bar-Ilan University in Israel. In Canada, he took up positions at the University of Calgary, at the Westminster Institute of Ethics and Human Values (London, Ontario) and for the last ten years at McGill University’s Faculty of Medicine and the Jewish General Hospital. He played a guiding role in the graduate Bioethics program at McGill, organized by the recently created Biomedical Ethics Unit.

His writings, characterized by exceptional originality, had a significant impact on the development of bioethics as an academic discipline. Although he published on a variety of issues in bioethics – notably consent, competency, HIV/AIDS, euthanasia – he remains best known for, and was most committed to, his work on the ethics of medical research.

He gained an international reputation in this field with the introduction of the novel concept of "clinical equipoise." In a 1987 article in the New England Journal of Medicine, he argued that an essential condition for an ethical clinical trial is that there be no agreement within the medical community on the question of whether the new treatment is better than the existing one. This concept has become a standard test in research ethics. It forms the basis of two major articles published shortly before his death in the Journal of Law, Medicine and Ethics, in which he and his co-author argued that placebo-controlled clinical trials are unacceptable if standard treatment is available.

He was committed to the idea that people who participate in clinical trials should never be exposed to a treatment that is known to be inferior. His approach to these issues exemplified what many admired in Benjy: in his continuous effort to strengthen the protection of the most vulnerable in society, he had the capacity to untangle difficult problems and to introduce a novel approach characterized by clarity and coherence. Dr. Robert Levine of Yale University, one of the leading experts in research ethics and a good friend, admired the simplicity of Freedman’s writings. "When reading Benjy’s articles, I often thought, ‘Of course this is it; why didn’t I realize this myself’?", said Levine.

Clarity and coherence are not the only characteristics of his writing. He also frequently went against the mainstream, exposing inconsistencies in accepted principles and reasoning. His rigour and originality were very much appreciated. The U.S. Fourth Circuit Court of Appeal, for example, adopted a new standard for assessing competency which he had proposed. And he was invited as an expert to assist organizations such as the Law Reform Commission of Canada and the Medical Research Council, in making policy proposals. He further served as a member of NCEHR’s Council and Chair of the Committee on Ethics of Research Design.

As a professor in biomedical ethics, Freedman was very demanding and somehow seemed to cultivate an image of the grumpy, severe professor. It was as if he wanted to compensate for his very emotional and empathic side, which people only discovered with time. For those who looked beyond his severe appearance, he was the kind of professor you rarely meet twice in your life. He was a true mentor: pushing students to grow beyond their own expectations, finding happiness and satisfaction in their success, and willing to learn from them. During rigorous questioning, balanced by witty remarks in real Brooklyn style, he insisted on clarity and coherence. You could leave a half-hour meeting with Benjamin Freedman with the good feeling of having untangled for yourself the Gordian knot. Looking back on it, you wondered why it took you so long. And as a truly Socratic philosopher, Freedman would not take credit for what he considered your discovery.

In his relations with colleagues, he showed the same passion for challenging people’s preconceptions and unsound arguments. As he did with his students, he demanded rigour and integrity, without consideration for political interests. He strongly believed that independence and critical reflection were an essential part of academic life, which brought him to oppose political compromises and the blunt power games of academia. He also thought that people working in ethics had a particular obligation to academic integrity and had to live up to that obligation.

Benjamin Freedman was a deeply religious man. His faith helped him to develop a sense of moral duty in all aspects of his life, even within sight of his death. After learning about his diagnosis, he called his colleagues and friends to discuss work he wanted to see continued with or without him. His faith also helped him confront the harsh reality of his disease with remarkable serenity. He wanted to show how one could live in dignity while facing certain death. But he also acknowledged his vulnerability and his humanity in this suffering and his need for support from family and friends.

His commitment to the Jewish community was expressed in his last work, "Duty and Healing: Foundations of a Jewish Bioethics" which he wrote on sabbatical in 1996 and which he published on the Internet (http://www.mcgill.ca/ctrg.bfreed/). (Selections from his work were also published in the Hastings Centre Report and in the Journal of the International Association of Physicians in AIDS Care). In his own words, he felt the need to write it, because it was the thing he would regret most not having done should something happen to him. Publishing this book on the Internet was typical for Freedman. He wanted to make it available to as many people as possible within the Jewish community and outside. Nothing pleased him more, not even a very good review in JAMA, than the knowledge that people outside academia downloaded his text and learned from it. This commitment to ordinary people characterized his work as a clinical ethicist, which he discussed in his book. At his bedside in the Jewish General Hospital, but also in his office at McGill, he took the time to sit down with people of varied backgrounds, who would find in him an empathic listener and advisor.

The sense of duty and commitment he had toward his profession and his religious community was also present in his relationship with his family. For Benjamin Freedman, spending time with his wife Barbara and their children (Ariela and husband Jeremy, Orit, Avidan and Menachim) was sacred. Prestigious invitations could not take him away from them. He was full of pride in their scholarly accomplishments, their talents in basketball, literature and computer games, and their social involvement. It was touching to feel how he loved and admired them, when he related anecdotes about them to colleagues.