Remembering Miles Little (28.12.33 – 30.9.23)

Remembering Miles Little (28.12.33 – 30.9.23)

Ian Kerridge, Wendy Lipworth, Christopher F. C. Jordens & Paul A. Komesaroff

Free Access Editorial.

The Journal of Bioethical Inquiry was established in 2004 with the explicit aim of being more than “just a journal”—more than merely a place where scholars and practitioners could publish their research, critical reflections, and analyses of bioethical issues and practice. Rather, it was established with the aim of fomenting bioethics as a process of dialogue within a community of scholars and practitioners that connected diverse voices in a global conversation across disciplinary, ideological, and geographical boundaries and encouraged the emergence of novel, innovative, and critical perspectives.

These goals were deeply consistent with the vision of Professor Miles Little and the Centre he founded at the University of Sydney—the Centre for Values Ethics and the Law in Medicine. Miles established the Centre in 1996 with the explicit aim of creating a space for new thinking and genuine interdisciplinary discourse and collaborations.

Miles’ personal capacity to turn visions into reality reflected both the expansiveness of his intellect and his commitment to bringing about practical change in the world. While it is difficult to capture this in words, Miles was someone who both possessed and practised what in classical philosophy is referred to as phronesis or “practical wisdom,” reflecting the achievement of excellence not just in everyday skills but also in judgment, virtue, and moral character.

Miles Little was a surgeon, a scientist, a philosopher, a humanist, a teacher, and a poet: a true polymath. Through the force of his ideas he was able to contribute to significant changes in the areas in which he worked. However, his lasting influence on those whose lives he touched derived just as much from his personal qualities—his integrity, kindness, thoughtfulness, hospitality, and wisdom.

Born in Sydney to Norman Little, an orthopaedic surgeon, and Marion Friend, from his school days, Miles was the beneficiary of an archetypical classical education. He attended the Cranbrook School in Sydney where he became Head Boy. At over 6’ 6”, his long, lean frame was instantly recognizable in any gathering. Pursuing his love of the humanities he subsequently enrolled in a Bachelor of Arts at Sydney University and became a resident of St Paul’s College. At twenty he was invited to the newly built University House at the Australian National University by its first Master, the legendary classical historian A.D (Dale) Trendall. Here, he became immersed in an extraordinary, exploratory intellectual environment, fostered by some of Australia’s most remarkable scholars from across the humanities and the social, natural, and applied sciences. The residues of this experience—the love of ideas and conversation, the benefits of listening and interdisciplinary dialogue, and the importance of kindness, critical reflection, respect, community and sagacity—were to remain important in every aspect of his life and work.

Miles’ respect for knowledge and ideas was not, however, restricted to the humanities but also extended to the physical and social sciences. This brought him back to Sydney University where he studied medicine, graduating in 1959. He completed his internship at Royal Prince Alfred Hospital (RPAH) in Sydney, where he subsequently worked as a surgical registrar, gaining his Fellowship of the Royal Australasian College of Surgeons (RACS) in 1963. Throughout this time, he also occupied various academic roles, as a demonstrator in Anatomy and a tutor in Surgery at both the Women’s College and St Paul’s College at the University of Sydney. In 1964 he became Clinical Superintendent at RPAH.

During his time at RPAH, Miles worked alongside Professors John Loewenthal, Frank Mills, and Rowan Nicks, developing a particular interest in vascular and hepatobiliary surgery. In 1966, he was awarded the Nuffield Dominion Travelling Fellowship, which took him to the University of Glasgow to work under Regius Professor of Surgery, Sir Andrew Kay.

Returning to Australia in 1967, Miles became Honorary Assistant Surgeon at RPAH, Senior Lecturer in Surgery at the Faculty of Medicine, and an Associate Professor in 1971. During this time, he was also an active teacher and researcher, conducting bench and clinical research on a wide range of issues including, among others, peripheral vascular disease, liver and pancreatic disease, and cancer chemotherapy. He published a book on the management of liver injuries in 1971 and another on amputations for vascular disease in 1975.

With the establishment of Westmead Hospital in Western Sydney in 1978, Miles became the Foundation Professor of Surgery, a position he held until 1996, and Chairman of the Department of Surgery until 1990. His brave and far-sighted decision to be part of the Westmead project—far from the established intellectual bastions of medicine in Sydney—turned out to be a key moment in his life, providing him with the opportunity to contribute to the successful development of the hospital and of health services more generally. Working as part of an energetic team that included Dr Bernie Amos (the CEO of the Westmead project and the first General Superintendent of the hospital after it opened) and Professor Peter Castaldi (Foundation Professor of Medicine) he helped create an extraordinary new hospital that placed the community in the centre of all its activities, incorporated a conscious awareness of social inequities, privileged multidisciplinary work, and saw research, teaching and clinical service as indivisible parts of healthcare. Under their guidance, Westmead attracted scores of clinicians, researchers, teachers, and trainees anxious to serve the community where they lived and practise a kind of medicine that mattered not just to the local community, or to the NSW population but to the globe. The enduring success and impact of Westmead Hospital—and the continuing influence of those who trained in medicine and surgery under Castaldi and Little or simply worked alongside them—is testimony to their vision, character, and work.

During this time Miles held visiting Professorships in the United Kingdom, China, and Hong Kong, and received numerous national and international awards for his work. In 1987 he co-founded and became President of the World Association of Hepatic Pancreatic and Biliary Surgeons and in 1993 he was made a Member of the Order of Australia for “his services to medicine, particularly in the fields of hepatic and vascular surgery”.

Then, quite remarkably, in 1995 Miles stopped practising surgery to establish an ethics centre at the University of Sydney—the Centre for Values, Ethics and the Law in Medicine (VELiM)—on the basis of his emerging conviction that medicine had lost sight of its moral base and humanist foundations and had been redirected to serve technocratic and scientific imperatives instead of the lives and interests of patients and their communities.

The Centre he founded attracted extraordinary scholars from many disciplines—ethics, philosophy, law, sociology, linguistics, public health, clinical medicine, history, anthropology, psychology, and the arts. The Centre created “conversational spaces” that privileged attention to lived experience, genuine interdisciplinarity, dialogue, methodological rigor, and critical inquiry. It enabled work that was at once empirical, theoretically innovative and generative of new practices.

The atmosphere at VELiM was uniquely constructive, lively, and intellectually daring, both rigorous and adventurous. Ethical principles of power sharing and inclusivity produced new thinking, new resources, warm collegial processes, and life-long friendships. Many of the scholars nurtured there have become leaders in their fields, establishing research programmes and centres of their own.

It was extraordinary, and unique, as such places of flourishing can be. Under Miles’ leadership, the Centre thrived and grew—to become the largest and most research-active bioethics centre in the Southern Hemisphere and one of the largest internationally. It established a Bioethics programme. It supported teaching and learning in qualitative research and the medical humanities. It provided a “home” for the JBI. It attracted higher degree students from many different disciplinary backgrounds, and it maintained contact with and relevance to the health sector and patients. Above all the Centre created a community—not merely an academic and social community but a moral community founded on intellectual generosity, hospitality, humane values, and conversation.

Miles remained Director until 2003, when he was succeeded by Ian Kerridge. At this point, rather than fading from view, he continued to foster new ideas, new relationships, and conversations about values, clinical medicine, the experience of illness, and many other subjects. He provided students and colleagues with security and the skills to think differently, bravely, and humanely. His door was always open and he was always willing to provide support, guidance, and maybe a concept, theory, or phrase that might help to tackle a moral or intellectual problem.

His own work continued to reach across disciplines and into multiple fields of enquiry—survivorship, illness experience, agency, existential distress, mortality, disability, liminality, virtues, silence, identity, value-based and person-centred care, decision-making and consent, corruption, peer review, ontology, methodology, epistemology and evidence, medical foundationalism, exceptionalism, terror, trust, discourse and communal norms, hope and despair, aging and dementia. His vision and creative energy, his distrust of power and medical dominance, and his emphasis on narratives and discourse was expansive and infectious. His work, which was reviewed in a JBI Symposium in 2022 (The Legacy of Miles Little, April 2022, Vol 19) reflected his breadth of scholarship. It did not adhere to a single theory or framework but was grounded in lived experience, history, place, context, and culture. It was rich, authentic, deeply humane, and always accessible, seeking not to provide an “answer” but to open up issues for examination and discussion.

Sadly, after all this fecundity, the final years were difficult. The loss of friends, the bureaucratic transition of VELiM from Centre to university network, his own increasing frailty, the social isolation imposed by an unwelcome pandemic, and particularly the deep sadness he felt at his wife Penny’s own illness, all impacted his own sense of flourishing and made him question his value to others. But as all those who knew him would remark, even doubting his own contribution to the world was typical of Miles. For the reality was that, even when confronted with personal, professional, and existential challenges, he remained vibrant, utterly lucid, endlessly curious about ideas and about the lives of others, and consistently supportive of efforts to continue the critical examination of values in healthcare.

The work of Miles Little will, and should, continue to encourage conversations about the importance of bioethics, about the sources of “evidence” and “authority” in bioethics, about how medicine should be practised, about the personal, professional, and social values that really matter, about the need to remain curious and reflective, about the need to be cautious of power in all its forms, and about the importance of service, community, and care. It is our hope that the JBI will continue to reflect his vision for a richer, more expansive, more inclusive, more critical, more creative, and more inquisitive bioethics.