Tony, this is an interview between you, Derek Hockaday, that is Tony on the 5th, on the 6th of May,
and I see that you actually did your first degree before you did medicine, is that right, at Oxford?
That's right. I did philosophy and physiology, right. So that was physiology.
And that was three years, was it? Yes, it was a degree called.
Yes. And which you did two out of psychology, philosophy and physiology.
And the idea of it was that you did psychology either with a philosophy, biased philosophy, psychology, philosophy or psychology and physiology.
But there was nothing in the statute stopping you doing physiology and philosophy.
Right? Is that what you did? And that's what I was only the fifth person ever in the university to do that degree.
Very good. And the reason was I wanted to read medicine and I wanted to be a doctor.
You knew that. I knew that. And I came up to new college to read Medicine and Change in my first week to PCP when I realised I
could do physiology and philosophy because I got very interested in philosophy in the sixth form.
So the idea of physiology towards medicine, but also combining it with philosophy just seemed perfect to me.
I mean, I had you been doing the Orthodox biology, chemistry, physics at school?
Yes, I did. Maths, physics. So to maths, physics, chemistry and biology.
Right. And did you just discover this or did a tutor steer you that way between being accepted into medicine?
I took a year. I had a gap year. They didn't talk that gap year then.
But I took a year off between my two terms, essentially between my Oxford entrance, which was an extra term in those days.
So I did my A-levels, then Oxford entrance, and then I took no sorry.
So I took A-levels in maths, physics, chemistry, Oxford Entrance in December, then two terms to do biology level.
And then I took a year off before coming up and it was in that year after I
got into new college that I discovered I could do philosophy and physiology.
And so in my first week I went to my physiology tutor and he was very encouraging
and said he'd always wanted one of his students to do philosophy who was there.
So that was John Widdecombe, the new college.
Yes. And so he asked me to go and see Jonathan Glover, who was the junior philosophy down at New College then.
And basically within two days, new college had allowed me to change part of the flexibility.
That's probably not so common these days. I think it is that numbers good.
But how much physiology did you actually do? Did you do the honours school of Physiology?
Effectively, you did. So people you did eight papers in all for physiology and for philosophy.
And I think if you did a straight physiological sciences, you did six papers in physiology.
So I did four rather than six and physiology. Were you doing a practical project then?
So for the physiology, I did.
I mean, there were a number of practicals and as the physiology part of the degree, I also knowing I wanted to do medicine,
did a bit of extra practicals which weren't part of physiology but were part of preclinical medicine.
Yes. But now I mean, part of their Markt work, as it were, is a project, a term project that probably hadn't come in your time, is what I would say.
Sorry. No, it had and I did one in physiology with Tim Holder. Right.
Which actually was highly relevant to what I went on to do in my doctorate.
So, yes, I did a project which was a special final year on year project in neuro development,
nerve connexions between the eye and the brain right in the very young or so what
Tim Horder was working on was so I'm slightly confusing it with my doctorate.
Subsequently, it was basically a goldfish and and it was Finian's whether if you cut the retina,
I'm if you cut the optic nerve of amphibians, it grows back and reforms the connexions with the brain.
Right. So that was the system. And then did you go down to London or so then John Milliken said he had encouraged me to do a doctorate and he said,
what would you want to do your doctorate in? And I said, neuroscience.
And he said, in that case, I recommend you do the doctorate before you go on to do clinical medicine.
He said, how do you say renal kidneys? I would have advised him to do medicine first.
And so one of the elect, one of the invited people who came to talk.
The 10th Quadrant invited was his doctoral supervisor, who was Mike Gaze, who was working,
and you knew him way back and you worked with George Gordon, that's why he went to Edinburgh.
He did. And that's right. He worked for George Bush. So he did his degree in Oxford, worked for George Gordon,
went to Edinburgh and then came to London as head of a Medical Research Council unit at Mill Hill, which the National Institute for Medical Research.
He came and gave a lecture when I was doing Tim Horton's the special project.
And I was so sort of overwhelmed by the lecture and so excited by it that I wrote to
my colleagues to ask if he would take me on the first and was a doctoral student.
So after OAP degree, I went straight on to the neurophysiology doctorate and did it in two years.
No, I did a doctorate in three years, but I during that time.
No, sorry. I guess I did the doctorate in the street three years. Yes, but you were doing IBM research too or not.
So at the end of doing my doctorate, I only had the I wanted to come back to Oxford in my clinical medicine.
The only exam I was exempt from was physiology because my PPE pedigree.
So I had to take all the other preclinical and I did those in one year doing the work at
the Middlesex Hospital because my doctorate was registered with the Middlesex Hospital.
So they very kindly allowed me to join both the first and second preclinical years
and do the anatomy and neuroanatomy and pharmacology and biochemistry and all those.
So I learnt them at the Middlesex Hospital but took the Oxford exam because I was exemplar physiology for Oxford and.
Great. And then you did your clinical trials in Oxford, right?
Yes. And what was your feeling about the physiology department?
I mean, any particular memories as an undergraduate? Yes, I found it very exciting and very thrilling, really mean.
Marianne Fernandes was one of my tutors in in the Neuro and Denis Noble with the biophysics.
I think, in fact, Denis Noble was the first person I'd go to for doing a doctorate because I had
done a level mathematics and had done a bit of extra mathematics at new college.
Just on the side with one of the with one of the research fellows there who gave me some extra tutorials and masonite.
So I liked the physics very much. Um, but as it turned out, for reasons like one that there is no one can take me on and say that.
Thing with my case worked, so I found the physiology department very thrilling at Oxford and the philosophy,
I mean, the combination, I don't know how many other universities could you do such a wonderful company?
And did you stay relatively clear of biochemistry and metabolic?
And so the four papers I did in physiology went to a neuro biology,
so basically Nyarubuye physics and general neurophysiology and then the other tided were in the cell science.
So apart from some of the biochemistry, the cell, I didn't do much biochemistry.
You know, when you came to do your clinical work, we were glad you had a long period getting there.
Yes, I, I, I felt I was more mature than the students who come straight through.
Yeah, yeah. And I think that made me enjoy it more in the way.
I don't think I had some of the anxieties that they had.
And of course clinical medicine is very much thrown into talking to patients, you know, across the board, all sorts of people.
And I think I had more confidence then than I would have done three years earlier.
And just sitting down with virtually anybody and talking. So what are your memories of the clinical years?
Oh, well, there are just so many exciting people around.
So my memory was Richard Doll, who was then very much.
I think he was. Was he? He was Regius professor. Yes. He came up and he had all the new students around.
And so there was a lot of a lot of sort of epidemiological thinking that was on the cutting edge.
I think looking back, I mean, for some someone just took it for granted.
But the professor of the Nuffield professor of medicine is really the one we mostly dealt with.
This was David Wetherall and Peter Morris was the professor of surgery.
So these were the two sort of senior clinical figures. And they were both immensely impressive in the sense that no one saw them doing clinical work.
And you could be with them doing clinical work. And they were, you know, very top people in their research fields.
So, you know, it's very exciting, I think, having those sort of leaders and then at the at the clinical level, I got my first medical firm.
It wasn't your firm. It was with Peter Slidin and Jim Holt or John.
How do you have Jim? Well, Eric.
And that they were very different people.
Yes. Jim Holt was a superb sort of clinician who taught me.
And I think he he taught me those, I think more probably more than anyone else,
that sort of basic clinical philosophy of sort of really listening and getting a good history
and doing the examination and in some ways giving them the fundamental weight so that,
for example,
if an investigation contradicted or seemed to go against what he saw from his state examination to not go necessarily with the investigation,
but to think very carefully. Yes.
And I remember we had patients in ICU and in all the ETU people will be measuring central venous pressure and things.
And he would be getting out his stethoscope and listening to the backs of the chests and say,
you know, this person's in mild heart failure, whatever the CBD line says.
And so that, you know, that was, I think, quite a major influence.
But I was and then I was also on John Ledingham Farms, one of them.
And, um, and, you know, that was enormously stimulating the I mean, I must say,
I think it was the general medicine that tended to excite me more than the surgery was about the A.
Now, that's interesting. Keith Horton was my guest.
Right? Sort of clearly there was my immediate mentor.
And I at that stage, I had no thought of doing psychiatry or anything that didn't come to doing my house jobs.
But it was what I was doing, my house jobs. And I just thought, what did I actually just enjoy?
I realised I join the society. So I did this account.
You just think I'm not even thinking it was a possible future political area, but I enjoyed it immensely.
What country do about it? Well.
When so when I was doing my house jobs and starting to think about what I wanted to do, pesthouse jobs.
That's when I almost had a Paulene conversion. I mean, I can remember the exact moment at which I suddenly thought about psychiatry.
And it was really the coming together of several things I realised when I was doing my house surgery where this is in Bath, not in Oxford.
Very busy job one into Rohter. So it's basically 36 hours continuous work and 12 hours off, 36 hours on.
You know, this is a terrible,
terrible and and I remember I was coming back at about 2:00 in the morning from having been called across to the hospital to see a patient.
I was coming back thinking, you know, I'm not this isn't really that sort of medicine I really enjoy, um,
and really to do those surgical jobs that what you had to do was clock as efficiently and quickly as possible.
So we had 13 patients come in on the Monday for the Tuesday morning for the Tuesday surgery.
And my Monday would be clocking thirteen patients, making sure they were safe.
And I thought this isn't the sort of relationship I enjoy in medicine.
And then I suddenly thought what I really enjoyed the relationships I had with psychiatric patients, psychiatrically ill patients,
the longer term sort of relationship and the thinking a lot about their problems as people, as they were, what their difficulties were.
So that was one thing about psychiatry.
Um, I I'm going to thank you for inspiring the combination of a careful and thoughtful science and evidence together with.
Sort of supporting people at a sort of emotional level, and I realised I liked using my sense,
my personality as part of the therapeutic skills, that that was something I liked about.
I liked thinking about psychiatry.
So that's a long term relationship and the kind of relationship and the kind of use of one's personality, the things I'm worried about in psychiatry.
And I suppose it took me a couple of years to to entirely get to come to terms with that was the in a sense,
the relative lack of complexity of diagnosis. Yeah.
And the lack of physical skills.
Because of my PhD, I done surgery on the eyes and brains of small creatures and, um, under the microscope in microsurgery.
And in fact, eye surgery was very high on my list, as well as a clinical student.
And I think if I were now studying, I might well have done eye surgery because in those days to do eye surgery,
I would have had to do, I think, four years of general surgery before I could specialise in surgery.
And I wasn't prepared for years of general surgery now. But had I been able to go into surgery as a speciality, sort of straight after housetop,
so then I think that would have been very high on my list is opthamologist.
I always have a very civilised life. I think you guys are like a civilised life just to go back.
How did you how did the middle sex anatomy, whatever its theology, compare, as it were, with the Oxford teaching?
That's a very good question and an interesting one, because I basically learnt of the middle sex and took the exams.
Um, I think the standard of teaching at the Middlesex was very high indeed.
In some ways. I think they took more care over the teaching than Oxford in the sense in class teaching something about tutorials.
No, um, but it is very much taught.
It wasn't the idea. You learn this yourself and you'll meet a few brilliant minds and there, which, you know, I think both have their strengths.
And the quality of the teaching was very, very high grade at the Middlesex Hospital.
And I, you know, were two or three teachers there who I thought were really outstanding teachers.
But I never but I'm not saying there wasn't good research going on, but it wasn't so obvious in the middle seats, perhaps because I was preclinical.
But whereas, you know, as an undergraduate at Oxford with a tutorial system,
you were brought in very close contact with the sense of research that how people who did research were thinking.
Yes. And again, I think doing clinical back in Oxford, you know,
I was very aware as a clinical student of not just the clinical work, but the research going on.
I think at the Middlesex, my experience was very, very good teaching, but not that sense of being close to research.
Yes. And which has geomedicine. Did you do?
So I did a slight hold. Yes. Because they knew because they hear me say.
And so then you did your has jobs and straight into psychiatry.
And that was another question I had so many people advised me to do, you know, LCP first and that sort of thing.
But I'd already done a doctorate and and an extra year because I'd done PCP, not medicine straight.
So I just said to myself, you know, I never want to do psychiatry at this stage.
I just want to go straight into it. And you enjoy that.
Yes. Immensely. Yes. No, it was so Bertie Mandelbrot.
It was my first year. You remember him? I do. So, yeah, on the Phoenix unit, which was an extraordinary unit at the Littlemore Hospital.
So I tend to do a little more on the warmth for the three, but it's very general.
Yeah, that's right. That's well, those are the same ones, you know. I mean, things like Banbury become part of the same organisation.
But it wasn't then, although I did do six months as a junior psychiatrist at Banbury,
so little more was the old county asylum, the one for the old private hospital.
Both have been integrated into the NHS and the Phoenix unit at the Littlemore Hospital,
which is now a luxury apartment and was an acute psychiatric unit run a sort of along the lines of a therapeutic community.
Right. Which over thirty one of the last of its kind, because that went completely out.
Five, ten years later, months, Bertie Mandelbrot's retired, wasn't a model that people followed at all, but as a genius psychiatrist,
it was an incredible experience because you were just thrown in there as a junior
doctor with all these people with quite a pretty severe psychiatric illnesses.
Um, and you were sort of every day we had a community meeting, all the staff, all the patients sitting around in one room.
And then in the afternoons, three days a week, as the junior doctor, I would be in charge of one small sort of community meeting with the patients.
So one certainly got a huge experience of mental disorder.
How good with the drugs and oh, by then they were.
So this was several I mean, Mandelbrot's himself had come in to Oxford in the early,
going to be in the sixties with the new antipsychotic medication compromising particularly.
And he was one of the people who, you know, who a lot of people were put out into the community who'd been previously in the hospital.
So by the time I mean, I'm bitter about the night I was I became a psychiatrist in 1982.
I suppose that by then all the major tranquillisers and the antidepressants, I mean,
there were somewhat different from now, but basically the main classes were already there.
So, um, but in a psychiatric drugs, so relatively few types compared with the whole of general medicine,
um, you referred to the definitive diagnosis of the sort of big bags of diagnosis.
I mean, how important do you think it is to become more discreet in the diagnosis?
Would that affect treatment? And equally, I mean, can you really tell a schizophrenic from a psychopath, etc.?
Yeah, yeah. Diagnosis is important in psychiatry.
Um, I think the more tricky thing than on your own terms is it would be schizophrenia and some kinds of depression,
whether or sorry, I say depression, but really it sort of affected areas with manic episodes.
Those can be very difficult. And I'm not even sure that there isn't a spectrum and no diagnosis is important, but it's.
Doesn't give you straight away the right the right way forward with the patient,
and there are you know, there are only a very few diagnoses really in psychiatry.
And even that you might have two people, one with a diagnosis of depression, with a depressive illness, one of the diagnosis of anxiety, neurosis.
And yet all the psychological aspects of the treatment might not be the same for you might have to pay
for the same diagnosis in which the psychological the the way in to help the person is very different.
So I think in Sicko, I've often said, talking to students, that I think psychiatry in some ways is more like surgery than it is like general medicine.
That is it's actually the it's the kind of skill it's it's not so much the diagnosis is crucial.
It's the skill with which you act as a therapist, right?
Yes. Yeah. So when did cognitive behavioural therapy come in?
Well, I very much was through that era. So my interest as a junior psychiatrist was a year after the first sort of three, three or four years,
I got a welcome trust training fellowship and then became a clinical lecture lecturer in psychiatry.
And my research interest was dementia, and partly because I knew that I was a brain disease and I was.
But I did have this fundamental interest in the brain and its diseases.
But in the department, when I was in the Department of Psychiatry doing half research half a century or half research and teaching and half clinical,
one of the big areas of research in Oxford was in cognitive behavioural, cognitive behavioural therapies.
So they were very much being developed really through the 80s and 90s.
And a lot of that work was being done in in Oxford and just to to leap ahead a
lot because I moved into Maine into medical ethics and communication later.
But I did come back to doing some psychiatry and I did the diploma in cognitive behavioural therapy.
But we're talking now about in 2005. So a big leap forward.
And how important is Michael Gounder in that? Well, Michael Gallagher was the first head of department heads in Oxford in psychiatry.
So he created and he created, you know, when he retired was one of the major research departments in the country.
And he inherited nothing at all. He just came he and then his gaffes, I think, and a bit of money.
And that's all he ended up getting. So he was hugely important in getting Oxford psychiatry research and the department more than off the ground.
And he had a very strong interest in behavioural treatments when he came to Oxford.
And it was really under his aegis, if you like, that the cognitive, the research and cognitive behavioural therapy and got going.
So. So it wasn't that I mean, he was managing a huge number of things by then, but I would say it was under his aegis.
Yeah. And was dementia hived off, as it were, spatially or it mean in terms of clinical, in terms of research, no clinical.
So psychiatry was still is really organised around age.
So there was old age, psychiatry was a kind of subspecialty.
So consultants in old age psychiatry would expect to have some different training in the senior period and the general psychiatrist would be so old.
Psychiatry was it was hived off and dementia.
There was one of the main conditions that psychiatrists dealt with, if you like.
I mean, it was always I mean, I've never felt that the dementia services have ever been properly integrated.
So you had people with dementia, might come onto neurologists, might come under old age physicians or might come under old age psychiatrists,
and which depended nothing to do with diagnosis, depending on what problems,
but partly on age and and on what problems they presented and who their GP was or not.
No, no, no, I don't think so. I think what the problems have, um.
And did you go on well when did you get the feeling you'd like to get involved in the ethical aspect.
Right. So one of the very inspiring people in Oxford psychiatry at that time was Sid Bloch.
Oh, yes. And an Australian nose.
Yes. Australia south. The South, the Australian. Yes, Australian film Origins.
And he so he was a consultant therapist, a psychotherapist.
And he was always very interested in ethics. And he edited a book on psychiatry and ethics, we know yuppy.
So he was encouraging people when he ran in every so often the departmental meeting would
be under his control and then he would want ethical issues to be raised and talked.
So because of my interest in ethics, I did some work sort of with his help, um,
a bit of a bit of very simple sort of ethics research, if you like, just on the side.
So that was one thing. Um, so Ziplocs encouragement is one thing.
This story in a way, personally goes back a bit further.
So I'd done philosophy half of my first degree when I was a clinical medical student, together with two other students, Mary Ryan and Mary Longmore.
The three of us are students, founded a student society in medical ethics, which we called the Oxford Medical Forum.
And that was really part of what was a national thing that was going on at the London Medical Group that,
um, that hosted in amongst the London medical schools and talks on medical ethics.
And so they formed a kind of national network, which we became part of.
But anyway, so as an undergraduate, I started I started this Oxford Medical Forum,
and through that I met Ron and Gilan, who was then he was for 30 years.
He was the editor of the Journal of Medical Ethics, which was the main by the person he'd been in Oxford.
He had medical student. He had said Christchurch. That's helped by this natural.
Stigman is interesting career, so he was then the editor when I was a medical student, he was the editor of the Journal of Medical Ethics.
And I think in my first year as a psychiatrist, just after my housetops,
he wrote to me and rang me up or something and said he was looking for an assistant editor and would I be interested?
So from early on in my psychiatric time, I became a sort of assistant to run and get on the Journal of Medical Ethics.
I was about half a day, a week of editing work. So I had this sort of thin line of keeping up my interest in philosophy and ethics from that.
And then there was, said Vlok, who was encouraging these ethics things.
And then the other very significant person really to my career was Bill Fulford,
who was another he was a psychiatrist who'd done his was under Michael Geldof's encouragement, which I think is very foresightful of Michael Gelder,
really, that when Bill Fulford had been a lecturer in psychiatry,
he wanted to do a doctorate and he did a doctorate in philosophy in Oxford with professor, warmakers his supervisor, Maribor, know what I mean?
And so there was Bill Fulford also in Oxford.
Now, I think an honorary consultant. When I was a junior doctor,
he was very interested in philosophy and the two of us got talking together and we started to plan out some seminars for
medical students in medical ethics because we felt that was a big thing missing in medical student education and so forth.
And I, working together, drew out a sort of plan for seminars that we were just planning.
We would give, you know, sort of, you know, spare time, as it were, and we sent our proposal to David Wetherall.
So as a threat. So this is nineteen eighty nine right to happened to David Wright and it landed on his desk,
I think very opportunely because he'd just been to some national meeting.
He told me often where people were saying, you know, what's happening about medical ethics in medical schools.
And the medical students at the time had done a survey of their students, of the student body in Oxford about what teaching they like,
what they didn't like, where the gaps were, and a big message from them to come back that there was a gap in medical ethics.
So both these things together and then on his table Lanzhou proposal.
And so he said he spoke for some reason. I don't know the history of this to Caroline Miles, who is the new chairman of the health authority.
And she was Selznick's Somervell person herself.
She had a burning interest in philosophy herself.
And anyway, so she and David Wetherall between them came back to Earth over to me and said,
we can make much more of this than just a couple of seminars that you might give.
Let's see if we can get some money and fund this properly and develop the teaching properly in Oxford.
And to cut that long story short, Dave, whether Caroline Miles went to believe a huge trust and got four years of money,
there's a proposal that really being fulfilled, that mainly written with my assistants,
and then they put it forward to of him and the lady who funded for years for Oxford to develop teaching in what we called practise skills,
which was ethics and communication skills together, and to develop it in Oxford in such a way that it could be of national value.
So to prepare the materials and to do some work around what's effective and what isn't, and and so that got funded.
And so this is really about the only time I ever feel I made a decision in my life in terms of my career.
My career up to then had just fallen out. Yeah, I but I was just at the same time as this was funded,
a plan of getting a proposal together to the Wellcome Trust to become a senior Wellcome Trust senior lecturer.
So I was I'd be in the a broken trust training for that.
And then I've been a collector and then the next rung up early for the Wellcome Trust funding was a senior lecturer.
So it was Michael Geldof's strong support and encouragement.
I was. Building up a proposal to the Wellcome Trust around my research in dementia and then deliver him trust, said they would fund this.
And so basically David Weatherall and Caroline Miles would put out an advert
for somebody who would lead that four years work to develop medical ethics.
And that was a really difficult decision. Yeah, and should I go?
This might was my future career in old age academic psychiatry or was my future anyway and developing this medical ethics and in the end,
for various reasons, I applied for me. So need this practise skills project it was called and I got that in the ethical teaching.
Were you aiming to advise people what to do,
how to act or to give them the reasoning that providing the rationale for telling them what to do entirely?
The second. Well, I ride a ride. I mean, this is you know, I always saw this as a university education.
Yes, fine. And this is about teaching people.
And now clearly they have to know the medical students have to know what the law is,
where the law is clear, and they have to know that GMC guidelines are very valuable, extremely important.
And I must admit, over the years, I am not talking about,
in my experience over that whole and the whole period of leading medical ethics in teaching in medical school,
the GMC more and more was becoming, you know, here's what student doctors have to do, more and more didactic, if you like.
And they were very keen that medical schools made sure that students understood the GMC guidelines and everything.
And that was, for me, a slight conflict between the philosophy.
But I was always very clear for myself that my purpose as an educator for medical students in a university,
so the university, like Oxford, is to be helping medical students to think through the issues themselves.
And one of the things I sort of would say to medical students is, you know, clearly you have to know what what's illegal and what is legal.
And in but over your career, just as I had seen over my career, things change.
And one of your jobs is going to be to contribute to what the GMC thinks is right and to challenge what the GMC.
And if I may just give an anecdote,
which impressed me about the Oxford students when I was teaching the students and the small group of students came to me one day and said that they
thought there was a conflict of principle in what the GMC and indeed in the sense the law was saying about consent and about confidentiality,
that conflict of principle being that all the law and everything on consent was lost to the effect that a competent adult could refuse any treatment,
even if it was completely against the best interests of that patient, that they could refuse treatment and even if they would get it done.
But a competent adult couldn't refuse.
From the confidentiality point of view, if a doctor thinks that they should breach confidentiality of a patient,
even if it's purely for that patient's sake. So we're not talking about danger to others.
In the end, that's a best interests criterion.
So that, in other words, a competent patient can't say you must not tell anybody about what I've just told you for my sake.
Right. And so that they encourage the students to write to the emergency and they produced a critique of the GMC position.
And that I'm giving this out because that's what I thought.
My job is to encourage students for that individual thinking, not to simply say, well, this is the law on this and this is law on that.
And did they win? Does incident as I know I too much to get.
I mean, the GMC acknowledged that there was the conflict and they would take it to discussion.
I mean, the fact is the conflict exists really in English law. Yes.
The messiness of the English law. So it didn't bring about any major.
Well, I mean, not obviously anyway, although I suppose over the years,
if you look at the GMC statements on confidentiality, they are more and more about respecting individual patient wishes.
So I suppose there's been a I mean, how how bad would you say was the ethical management of patients in the seventies?
Well, in the snow in the late 70s, I was a clinical medical student and one of the things that led the three of us, I said, who founded this?
A society as medical doctor, medical forum, one of the things that precipitated us to do that was a conflict that the group of us on.
This was on a surgical firm. So we were first year clinical student, zero six of us, I think, because of much smaller medical school in those days.
And there was a patient, an elderly man who had pancreatic cancer and he didn't know we discovered he didn't know.
And with some trepidation, we confronted the consultant surgeon with at least about we said he doesn't know.
And we think he said and we were all unhappy at this patient.
And the consultant surgeon said, well, he's not going to be told.
And I believe he should be told because he'd only make him miserable. And but there was a sort of generational difference.
I think I was I guess I was the first generation that that felt that patients should generally know things,
even if it wasn't a perfectly nice thing to know. I mean, so now I.
So I wouldn't say, you know, the people in the 70s, the doctors were being unethical in any personal sense,
but I do think some of the expectations and standards then were due for the change and for development.
And things have changed. Now you're teaching. Would you be teaching for one term or I mean, how did you manage the practicalities?
Right. So so once I got the job of the leader of the Practise Skills Project, I had to develop a curriculum.
And here I should acknowledge Bill Fulford from the point of view of ethics and Theo Schofield from the point of your communications.
It was he who recommended I interview very warmly. Sorry, carry on.
Well, he was absolutely so the idea of practise skills was that this combination of ethics and
communication wasn't being taught to medical students at all and that that's what they did,
develop them. And we saw them as kind of somewhat together.
So that that's sort of clinical skills, if you like. I mean, maybe that's a slight oddity.
But there were skills of diagnosis, of taking a history from the diagnostic point of view.
And then the ethics and the communication was sort of a slightly different kind of skill that had to be integrated.
That was how we saw it anyway. So we saw ethics and communication was quite close to each other.
So the idea for those four years was that the two would be both be taught.
And that was my job as leader of the Practise Skills Project, was to develop the teaching in both.
Now I have something of a background as a related, as it were, in philosophy and ethics,
but I didn't really have any background, particularly in communication skills, in medical communication skills.
I mean, other than that, nothing.
And it was already become communication skills were becoming, you know, their own field with their own research and things.
And so Theo Schofield, who was a GP, local GP,
who have been one of a small group of people who are pioneering the teaching and examination of communication skills in primary care.
It was his expertise that came to the communication skills.
So although I had to do a lot of the nitty gritty of making it happen and finding them the timetable and all that of the communication skills,
from the intellectual point of view, Theo was really the leader of that.
So he was very significant. And so so the course was in ethics and communication skills.
It was only in the clinical years of Oxford's way of doing things.
It couldn't be integrated across the six years because if only because they were different students, I mean,
only 40 percent of the preclinical Oxford students would be clinical students and only 40 percent of the clinical students.
And so it was in the clinical years. So we had those three years.
And what we did was, well, initially that it was surprisingly difficult to get timetabling everything because there was no timetabling.
A lot of the consultants are a and it's always a huge backlog.
I remember it. I don't have to there.
But nonetheless, they did. Well, they do remember that. Yeah. Yeah. So anyway,
so what I had to do was find on each firm one of the consultants who was interested and would find a bit of time when we could put in the seminar.
I mean, later it became part of the course. But there was this period when I really had to negotiate with every clinical,
whether it be medical or surgical firm, to find when we could put in the teaching.
But what we what we aimed at was seminars with the students who were on the phone together so that if we're talking about the early 90s,
when this was 1990 to 1995, that would be a typically 12 to 18 students.
So that sort of seminar size, um, so I'd repeat,
we've repeated seminar six times with the different groups of students from the seminars would be basically a short half day,
two and a half hours, three hours with a break.
And we did three or four and the what's now called what was called the forum thing, typically one of the first clinical years.
And then in a couple, two or three of the specialities, very little in the final year because the students didn't have they weren't so much in groups.
It was much more difficult time to move it. So I think in those early years, I did one or two lectures to all students in the final year,
but most of the teaching was seminars in the first year and second year.
So no firm did you go to David Smith or Malcolm Benson, Malcolm Benson, because he'd been my I'd known him from earlier because he'd been with hopes.
And yes, he had. That's right. So I've been his house.
Right. Because for whatever reason, maybe you inspired him.
He took the philosophy in a way. That's right.
Yes. Isn't that interesting? And do you think that was after you tackled him or did you already think he was?
Yes. Well, I wouldn't want to write his history.
And I'm sure you saw my memory is that he was a very busy our time and he had an interest.
And so when I talked to him about this, he was very keen that the students would great to have some.
But I think he actually became interested in it from his post.
I think he the Masters also. Yeah, I think he did that in the late 90s and early 2000s, but I'm not sure.
So how did you assess your success in teaching things?
We we are not so in the end that it worked.
But we did do a not a controlled trial because we couldn't not teach some students and teach others.
But what we did do is we developed a sort of exam, but it's an exam for research purposes, not passing students,
which was basically a response to a case which we then developed a very clear marking system.
This is all influenced by my experience in doing research in psychiatry.
And what we did was we gave it to students because of the way we taught.
There were periods when you could have a period where one group of students had had some teaching and another group hadn't yet had the teaching.
So basically at time delay and we also did it before and after with the same group of students.
So but so we did to do this test a before and after.
And students who hadn't yet had the teaching, students who had had the teaching and looked at the difference in results and found
significant differences and published that in fact in the Journal of Medical Ethics.
But to be honest, I'm not sure that that was a terribly good and scientific for the liver who had to do something.
Well, interesting. Mary Warnock, you mentioned her. She was on our advisory panel we set up due to Caroline Miles.
And I must acknowledge her in this part of it because she gave enormous support to getting all this done.
And the bit beyond what you've talked to me about, an enormously significant.
But she set up this advisory panel. Mary, when I was on the tour, Mary well, that was very negative about this kind of a scientific attempt.
She said, you won't really get at the issues.
And the positive thing that came from that is we didn't give it up, but because of Mary Warnock's insistence,
we did a lot of much more qualitative work around student feedback and feedback from.
We even got feedback from patients. Yes.
So that I suppose we developed the teaching probably more influenced by that sort of qualitative feedback than by the results of our.
See, what intrigues me is that in the tests say yes now that with some things about the GMC that there's been no doubt I was correct.
But how confident are you that any one answer in the more general questions is correct?
Yeah, I mean, we've had this issue not just for trying to assess the quality of our teaching, but as later on.
But by the early 2000s, students were being examined in ethics as part of their examination.
And that was something I was always keen at some stage to bring in because everything else was being them.
But but an issue that we kept addressing and going back on is how do you test students competence in medical ethics?
Um, the. I mean, so there are the easy things to test as the factual content is,
and I think that's not particularly different from biochemistry, that's the ethical thinking.
So in that is the bit of research we are actually wanting to test ethical thinking.
So we did do that fairly thoroughly in a way, because what we say we part of that test was students account of what they do and why.
So it was an open again.
And we then did develop using interactive reliabilities that we had Bill Forefoot and me and I've course, one other person, Chris.
I think it was a lot to be done sometimes then and Mark, you know,
so we develop we developed some sort of criteria and then we'd have other more of the same scripts and the current rate of liability.
So we tried to do it fairly formally.
I mean, I am a bit sceptical in the end how successful all that because again, patient feedback, it depends which patient, doesn't it?
Absolutely. And so that's not, you know, not for quantitate mainly.
That's sort of a qualitative. So when all this is going on, you are still working on dementia.
So from 90, 90, 90 to 95, I was almost full time.
I was sort of had half a day, a week not on the practise project.
I did a bit of clinical work, but so standing in for people in Geldzahler patients when they're on holiday occasionally.
And I still I had an MLC fight of what was originally a five year grant application that was then extended for two years.
So I had a seven year MRC grant that extended. I'm tending to look at behavioural problems and dementia.
And so so the dementia research side started in the eighties,
was around the problems of behaviour that people with dementia have, like aggression and wandering and overeating.
And, um, that that kind of the sort of issues, the problems, the psychiatrist that made them difficult for carers to look after.
And so I wasn't I mean, essentially, I was overseeing this, helping to write the papers, hoping to analyse the results.
But there were people paid on the project to collect the data. So I wasn't having to do the primary collection of data on them.
So that was only about half a day to day a week of work.
And then for some reason, I connect Katherine Oppenheimer say, to dementia work.
Is that correct? That's absolutely correct. And I was a senior registrar.
That was then when there's an old age psychiatrist.
Um, and I did her locum, her consultant locum just at about the time I was moving into the ethics field.
Um, and, you know, a lot of the patients in my dementia studies were patients who she, um, had put me in contact with.
And she is always very supportive and helpful.
So, you know, she was a major influence on and certainly on my clinical work in dementia and in area where the whole for where you have optimal.
Very much so. We worked together, in fact, um, so I was approached by Kim Jobst and met obviously with David Smith as well.
And so I was already doing research in behavioural issues and dementia where Noxzema was starting going.
And so we talked a lot about what they would need in terms of the of the information about the patients.
So they were collecting brains, post-mortem brains, but they also need to relate that to aspects about patients.
And one of the aspects that they they're interested in.
Well, which I think after talking with me, they're interested in what the behavioural aspect is,
partly because they could confuse some of the other issues so that patients were
eating a lot that would have an effect on the chemical things they were measuring.
And partly also, um, we were our joint interest was to potentially relate behavioural problems with post-mortem brain changes.
So and I and I was collecting, as it were, a cohort of patients.
I treated a cohort of 103 people who we followed every four months up till death.
And then we had permission for post-mortem on their brains from those who gave permission.
So so I already had that up and running.
Then Ottmar came with a much. Big a group of people getting post-mortem consent,
and they did a simplified version of my behavioural information and I had a control group, so they had a control group.
I didn't because originally, because my interest wasn't post-mortem brains,
it was the natural history, if you like, in the of the behavioural problems.
But that's right. But they and that was, you know, tremendous value to me.
They had control groups. And so, in fact, I have been writing papers in dementia up to four years ago.
So 15 years after really I was doing actually working properly in the field.
And that's because the biochemistry has been done on the brains of people who I was from, the cohort.
I said, did you write papers with Kim and David Smith? So we wrote a few papers and then most of the papers I've written in the chemical
field have been with people have gone to Syria and then some of the biochemists.
Right. So, yes, it's that some sort of another wing that was going on at the same time as I was developing the ethics.
And how much did things evolve and the interaction between the hospital and the
community over all this time and dimension in anything in psychiatry but in dementia?
Partick. And so psychiatry in general, if we're talking about the 80s and 90s,
those strong moves towards moving people into the community and out of the home where people in hospitals that
affected old age psychiatry and dementia into the more sort of day care facilities and fewer inpatient facilities,
um, and with a more sort of rural hospices, hospitals, whatever you like to call them, nursing homes where people would be put.
Oh, yes. I mean, there were certainly fewer beds in the hospital beds, so they had to be some services.
This also was going at the same time as local authorities were getting rid of their home.
So they were all being privatised. But there were a lot of private homes springing up.
I mean, thinking on the acute psychiatric side when I was a junior psychiatrist.
But the number of acute admission units went from five to three, I think.
I mean, as my work as a senior registrar, I would not be called a specialist.
A lot of that work is going out on call and seeing people in the community where
GP's call you out in emergencies with a view to the person being admitted.
And in the the three or four years that I was doing that sort of work as a senior registrar.
The criteria for admitting patients went up and up and up, simply not because of changes in therapy.
That meant that patients didn't come into the hospital just because the number of beds had
decreased so that people actually who are in hospital had to be more desperately ill as well.
So it's really I think the reduction of beds in the hospital changed and had to change clinical practise.
But do you think that was, as it were, justified or acceptable or a good thing?
I felt it wasn't. To be honest, I actually felt towards the end of my that period that I was having to say,
oh, well, you know, see this patient or that patient patient.
So I would actually have wanted to admit. But they weren't because it wasn't so already, I understand, on the ward.
So no, I actually felt distinctly uncomfortable that we were not.
I was. Whereas I would say at the beginning of that period, I felt I was genuinely doing the best for each patient that,
you know, making the decision was in their best interests.
Towards the end, I was feeling that their best interest would be to come in the hospital, the hospital.
But there weren't the facilities for that. Now, you're very involved with the ethic of getting established, then once it was really running.
Presumably you do a degree went back to some psychiatrist.
No, no, no, no, no. So from 90, 1990 to 1994, 95, the lot of the work was developing the teaching and ethics and communication skills.
And we had that original funding from the Living Trust then in 95,
Oxford really couldn't get rid of all this because the GMC by then was saying you have to have teaching and ethics and communication skills.
And Oxford had one of the leading courses in that because one of the few that have been developed full time by somebody.
So Oxford created essentially a senior lectureship university lectureship, which I applied for and got.
So that was that's the first time that I had a university post that was tenure track, if you like.
So it was 1995 on ninety six of them,
which one year was plugged with money that we agree hopefully got to the end of
the leave him just in the beginning of the university taking over the post.
Now once I got that tenure track sort of senior lecturer,
university lectureship in medical ethics and medical ethics and communication skills originally really practise skills, I thought.
Right. We've got you know, we got the teaching up and running. It's still going to need a lot of input.
But I've now got long term. I'm now essentially a senior lecturer and I want to be doing research as well as teaching.
And I had a very interesting discussion with Caroline Miles, who was still in those days, chairman of the health authority and the very wise woman.
You knew that you had a very good political sensitivities with a small P as well.
And I was talking to one shortly after I got this university lectureship and she asked a question around, you know,
so do you want to sort of just do your own research on medical ethics and run the teaching and be as
low an academic because you're the only one essentially in medical ethics in the medical school?
Or do you want to build up some kind of of medical ethics?
And I was really sort of the question by that before.
And I gave it some thought and I thought, well, actually, you know, I don't want to just be the Sloan person.
And if I'm one person, in a sense, it's going to be too much teaching work if I'm the only person doing that.
And I do want to do proper research on medical ethics. And I moved into the field, so I thought, well, actually a centre would be much more valuable.
And just about this time, the trustees of the Martin Wills Trust had come to John Ledingham and said that they were wanting
to essentially try to support improving the ethics and communication of doctors to back over it.
Well, to generate yeah. So it was their wills as a family, but they got out of tobacco, got to know quite well in the fifties and sixties and had.
And that made it clear to me that I wanted to start as a senator.
So where is it based? So then various departments could take it on.
And Martin Vesey, who was a professor of public health, was the person who was really keen to have this work in his and his department.
So my post was in public health, not in psychiatry.
No, my post in medical ethics. And yeah, um, and we had this money and Caroline Miles very sensibly said, well,
for 500000 pounds is best for us to set up a trust outside the university that can manage that money.
So we set up the Ethics Foundation, which received the 500000 pounds,
and then could use that constructively with the university to use the money to make things happen.
And the other piece of very good advice that Caroline Mills gave at that time was,
you know, I said, well, 500000 pounds would get a reasonable interest. So perhaps we should invest it and use the interest to fund some work.
And she said that's completely the wrong thing to do.
I said we have to spend this money over maybe over five years and we've got to spend this money, make things happen,
and then you'll be in a position to raise agree with that, because I, uh, that I had never done this kind of thing before and I was very well.
So that's what we did. So we set up this foundation.
Carol Miles is the chair of the foundation.
I was not formally part of the foundation, but I sort of but I was in the centre and so I would come and say what we wanted money for.
And that was a very constructive relationship because it gave me a bit of a barrier.
I mean, if I just had the five hundred thousand to spend to develop medical ethics, the Medical Ethics Centre in Oxford,
I can see that I could have spent the money too easily and wasted quite a lot of it.
But I had to justify I had to make a case.
And then also we could come to the university and say, well, the foundation will pay this if you pay if you do this.
And we could go to other people who couldn't give directly to universities but could give to charities and so
that we could access money that we wouldn't have been able to access if it was all within the university bank.
And so you're administering and teaching in the ethics course for the students you're researching in ethics yourself and your district to it,
I'm sure. So how much clinical work to do on doing so?
I then I stopped working for about a year, so I suppose from about ninety five, 96 to 2004, 2005.
And so for ten years while I devote because I saw it was a full time job to create a centre from nothing really.
I mean I had a huge amount of help from people, so I don't want any of this to suggest that I'm alone in this.
But you know, I was leading it and running it and it was and I had to do a lot of money fundraising.
I had to keep, keep and carry on developing the teaching. And as you said, fundamentally, I'm an academic at heart and I wanted to write and publish.
And in medical ethics and particularly psychiatric ethics, you specialised.
And so for those ten years, I did no clinical um.
And then around 2005, we'd head hunted somebody on some of this multimillion dollar, um, Mike Parker,
who was incredibly good, so good that he got the title of professor from the university.
And also remember the university when the medical school was enlarged to have more money coming into the students.
And they put they said anybody can be paid for.
And we've got the money for three new senior posts in the medical school sort of academic posts.
And so I think I put in one around Mike Parker's post for a new senior post in medical ethics and that a post in medicine,
in post and surgery were the three that were funded. So that so that gave Mike Parker tenure.
Right. And then in 2005 or so, I handed over directing ESOP.
So we call the centre of the ethics centre and is still in business department also still better than the now population.
Yes. With health and um. So yeah.
So I handed over the directing of it to Mike Parker for various reasons, which but I stayed in the centre until I retired in 2010 12.
Um, so when I handed over being in charge of the whole thing, that gave me some extra time.
So that's when I did the deployment to pay the price and then I did sort of Half-Day it.
We were taking people off the NHS waiting lists for CBT for therapy.
And there were two. Haven't I asked you about that?
I should have. Well, I suppose the sort of ethics research you might be so that the success of the
detox centre is now has 17 academics and three or four such staff is quite a bit.
And how many of those are medical? Um. I think when I retired, I was the last one on the staff who was a qualified doctor, right.
Okay, so gradually. So I think that's right.
I to get it going, it was crucial that I was a doctor. Yes. I think I wouldn't have been taken seriously.
But by 2005, you know, the world had changed most medical ethics teachers around the country and no longer the doctors,
but the people leading it are people usually with a philosophy background and the research being done,
increasingly being done by philosophers and social scientists.
But of course, with close connexions, they have to be people who can make good connexions with clinicians and researchers.
And that's been one of my Parker strengths.
So he's a philosopher by background, but he has enormous respect for and they do have medical scientists and clinicians.
Um, but that's the sort of what you call unique selling point these days of the Issac's Centre in
medical ethics is that it's a centre that's very close to medical practise and medical research.
So unlike a central philosophy department, which might be more remote than that.
Um, and so we do my personal research and I know that the research done a lot of it is quite empirical.
Um, so one of our big projects through the person who came to the doctor with me just into town, it was a quite senior psychiatrist,
very interested in anorexia nervosa, which raises a lot of ethical problems in the home case management of anorexia nervosa.
And her research involved very detailed, um, interviews, if you like them,
with people with anorexia nervosa about their whole experience of the condition.
And then we use that that those raised all sorts of philosophical and ethical issues.
I mean, a lot of people spoke about the anorexia being a separate part of their personality,
so separate that there were issues about responsibility in terms of their chances.
So in a lot on on how much control people have over their own behaviour, the whole is in all to our minds.
It was a counterexample to how competence and capacity was being analysed in law and philosophy.
So in other words, most people with anorexia nervosa would pass all the capacity tests.
And yet the sense from these interviews was that this isn't our view.
This is the model of the views of the people with anorexia,
that they didn't really have capacity to refuse treatment even though they would pass all capacity test and so on.
So one of the areas I don't quite a lot of writing about is capacity and anorexia,
but based not purely on, you know, sitting in an armchair philosophy based a lot of personal accounts of.
So I suppose my you know,
my real interest in ethics research is being very grounded in people's own experience in the people is people with the condition of their experiences.
Is there a new approach to understanding the pathogenesis, the reasons for the mechanisms and mechanisms of anorexia?
Well, that's a huge favour. So there's no quick answer. There's no I mean, a psychoanalytic.
Oh, yes. No, I know the answer is that nobody really meant.
And, you know, even from our work, there's a lot of variation in how and why people seem to be on a show.
I mean, this sort of simple idea that, you know,
some people put forward that they're trying to remain prepubescent and know that clearly doesn't work with a lot of people.
Um, you know, the idea of wanting to control everything, you know,
it's more there are some people who say, oh, they really do fit that that stereotype.
But then somebody else is very different. So so that's just a given what he talks about.
So he talks about combining empirical research with philosophical analysis to try to make a difference to real practise.
And what Mike Park has done is taken it forward in doing a lot of work with the medical scientists in Oxford and particularly the tropical network.
Mm hmm.
Well, there's a lot of large research, say, on genetics in developing countries which raise enormously difficult ethical issues to the research.
And what might that say, Mike, does research in combating.
Those researchers, but also provides ethics support.
And that's the other branch is giving ethics support to the to the health service and to researchers.
I know you can answer this, but if you take medical students in sort of 2000, you know,
when they do that and you feel that they practise general practise hospital more ethically than people 40 years ago, huh?
Well, there's also a slight side question.
I've noticed a big change in medical students between 1990 and 2000 and a big difference in their interest in medical ethics.
So in 1990, I would say in broad terms, there were 20 percent, 10 to 20 percent of students who were interested.
Really interested. Mm hmm. Uh, so 20 percent, 40 percent, though, 60 percent would have, you know, if 212 well.
Were willing to go along with you, but had no particular risk.
And I'd say there was a good 20 percent when I started teaching who were positively antagonistic, really difficult.
And your seminars were difficult because there were different students who were really I was in 1990.
By 2000, that had changed enormously.
And I would say in the last year, in the last 10 years, really, of my teaching,
two percent might be against at least two students in the whole year, 140 might be antagonistic.
And I would say the number who happens to be interested interest it would be 40 or even 50 percent.
And so I think in terms of their thinking and interests and I think and I'm not putting this down to my teaching,
particularly, I think a lot of cultural changes that have taken place.
But I think modern students and modern doctors are probably are more concerned about patient autonomy.
So, yes, but that's a huge issue. That's been a change. Change. Yeah.
Yeah. But I think I hope also more confident and I think we're teaching this is where the teaching might have more of an effect,
more confidence and being able to express themselves.
In fact, one of the feedbacks quite early on from John Ledingham said to me just before he retired, I think he said,
I've noticed since your teaching students now contradict me about some of the ethical things in here,
or I'll say, you know, are you sure that's the right thing to do from an ethical point of view, which he'd never had, and let's do it in the world.
I was good. So I just started to find it.
Final question for me, but what of your publications you're proudest of?
Well, I must say probably none of the things I've talked about. I think in many ways the Oxford Handbook of Clinical Medicine,
which Larry Longmore and I wrote the first edition of and then the and that's clearly been you know, I've been amazed how successful that was.
And that's been a real because that's what they has been having that book.
Yes. Yes. She's an onion. So Larry Longmore and I, both of whom started the Oxford Medical Forum together.
I also wrote the first edition of that book, and then I stayed on it for four editions.
And then really when I started the practise, when I started when I stopped,
really when I got the lecture, this lecture, because it's just it was it was a cottage industry writing.
Yeah, indeed. A is just just this year, retired from it after nine,
ten editions as you way back when you were students in Oxford setting up that group, did you have meetings in Oxford or just in London?
No, no, no. All the meetings in Oxford. How often did you have something like three or.
Right. And you would get people in to talk from London or from anywhere or.
Absolutely. Had a bit of a budget which. Yes. You know, agree. Was very helpful with helping us at.
We looking back on the most. I mean, this is if you want something good about Oxford, mean, this is fantastic.
So here we were, clinical students. I'd forgotten how we got connected with Grey.
But he said, well, what you need is an advisory group. So they much like Caroline Miles a few years later.
And he said, well, I think I've got you. I can get some people together.
And there we were, three medical students in our advisory group, which met twice a year and advised us on speakers and topics.
And also their contacts brought in very good speakers chaired by Richard Doyle.
Well, uh, Derek Parfit, who is in the philosophy world, I mean, Derek Parfitt is one of the superstars of philosophy.
I mean, just an amazing person to have only and we had the greatest political reasons, but one of the professors of theology, um, uh, we had, um.
Yes, um. So my subsequent Nobel prise winning economist, Amartya Sen, yes, and Amartya Sen.
So we had Derek Parfit, Amartya Sen, Richard Doll chairing it.
We were just typical students with this inputs.
Wow. Well, that is the kind of I didn't know. And then working on the clinical side, you know, patients what and you've got the answer to something.
But what are you proudest of in the way that what you've done is changed clinical practise?
I think in contributing to making ethics a significant issue in her medical practise has.
I've tried one of the people to the doctor with me and Slater, who's now a senior lecturer at Warwick,
see sort of with my help and support, has set up the first network of clinical ethics support services in the world.
So about 90 hospitals around the country have clinical ethics support services and which are not like research ethics committees.
They're not there to say yes or no. They're there for clinicians to seek advice and purely advisory.
Um, and Britain, I mean, those sorts of support services are already going in the United States, but not very much else around the world.
Britain has the first which we set up for that. So that was the main person for this.
And the first network of such support services, which has become a model for all sorts of several European countries,
now have networks, which has been very much set up, modelled on that.
So I think on the clinical side, probably that's what I'm proudest of.
Can you just about to switch off any final thing you want to say?
Well, I think just one final thing about Oxford is that serves as a health centre in medical ethics,
in the medical part of the university medical sciences division.
And then in 10 years ago, the ahero centre was set up, put together.
So all together. Sorry, go on. Where's the word come from?
So you E.H., IRA, it comes from the Japanese foundation that funded mines in Nigeria.
And it's very. This is right. Yes. And so the university also has the ahero centre of practical ethics, which is in the philosophy department.
And that centre was funded by the Japanese foundation, the foundation,
which was interested in funding something in Oxford amongst the practical ethics,
and that partly because he thought the centre world existed, they thought, OK,
so it would be a good place because it was already work being done in medical ethics.
But they wanted practical ethics more broadly and they wanted it to be in the philosophy department,
not in a medical department, but partly because of the ethos into the Oxford attracted that funding.
And so the O'Hara Centre now exists.
That's in the philosophy department that's been tremendously successful under the leadership of Professor Julian Saphenous.
And so that's another part of the story of Oxford Practical Ethics.
And it also makes Oxford almost unique in the world and having two centres, one in medicine, one in philosophy that work closely together.
And they both work in the areas of practical ethics and great medical ethics.
And in fact, unions have leskie, although in the philosophy department known throughout the world as a philosopher, has a medical degree.
And so part of his whole interest and and so he and I, when he was setting up work very closely together because we had such close interests together.
But again, I think that's an illustration of how.
How does something slightly anarchical about Oxfordian go right to the top,
can't stop things happening if there's a bubble of interest, and I think that's one of boxwoods, great strengths.
And I think the example of having these two centres that are highly complementary but very
differently located can work very well together is a good example of how Oxford can work very well.
I think we'd better stop that. Thank you very much, Tony. That was terrific.