The great physician Sir William Osler and the renowned neurosurgeon Wilder Penfield are both thought to have been Canadians. Osler, the father of internal medicine, was certainly Canadian, hailing from Bond Head, a small town in Ontario and part of a long line of distinguished family members (1). But Penfield, a neuroscience pioneer and epileptologist, was an American. He was born in Spokane, Washington (2,3).

The mistake is understandable because the two are national heroes in Canada. Their lives intersected in so many ways just as streets named “Sir William Osler” and “Doctor Penfield” intersect in Montréal at the foot of Mt. Royal, running through the heart of McGill University. Penfield was a student and protégé of Osler and both have been honoured with Canadian postage stamps. The Penfield papers are housed in the Osler Library of the History of Medicine at McGill. But truth be told, Penfield was indeed a Canadian. He became a naturalized citizen in later life.

But what is truly noteworthy is their respective trajectories in America and Canada. Osler, the Canadian, made his mark in the United States as one of the four founders of Johns Hopkins School of Medicine, the medical school that was the model for the Flexner Report (4) and for the origins of modern medical education. While future reforms would follow, Osler’s pedagogical contributions to that early template were enduring. Penfield, the American, founded the venerable Montreal Neurological Institute (MNI) (5), a truly innovative place which engaged in both basic and clinical neuroscience research. A stone bridge stretching between the Royal Victoria Hospital and the MNI remains a concrete and metaphorical connection between the laboratory and the clinic (6). Penfield’s vision for translational neuroscience became the model for the US National Institute of Neurological Diseases and Stroke, a component of the National Institutes of Health.

What is interesting, and indeed paradoxical, is their mix of geography and biography. Osler, the Canadian, had his most productive years in Baltimore while Penfield, the American, spent his professional life nestled in Montreal. Contrary to their place of birth, each country benefitted from the contributions of one of its neighbour’s sons. America enjoyed the fruits of Osler’s ministrations in Baltimore and Canada from the generative creativity of Penfield in Montreal. The irony could not be clearer: Considering, the current disputes over tariffs, one could say the Osler-Penfield exchange was a fair trade.

And that’s the point. Fair trade benefits both sides. The contributions of that early exchange continue to accrue since the founding of Johns Hopkins in 1893 (1) and the MNI in 1934 (5). They extend today to bioethics and modern neuroethics where there is a deep collaboration between our countries in joint scholarship and in a legacy of binational leadership of the International Neuroethics Society (INS), the field’s leading membership organization.

As INS president, I was delighted to have brought our first non-US based meeting to Montreal, where we were graciously hosted by the Institut de Recherches Cliniques de Montréal (ICRM). On a personal level, the implicit strain of clinical neuroethics that threads through the work of Osler and Penfield informed my own writings on disorders of consciousness (7) and neuromodulation (3,8). In the face of nihilism in neurology and neurosurgery, Penfield was more optimistic about the emerging therapies he was developing, including the electrical stimulation of the brain in his work on epilepsy (9). His writings have been an inspiration to me and my colleagues (10).

I have been honored to write the epilogue for two editions of the Oxford Textbook of Neuroethics (11,12), co-edited by University of British Columbia’s Judy Illes, herself a former INS president. Closer to the East Coast, I have shared a pragmatic approach to ethics and neuroethics with Montreal’s Eric Racine (13) and legal scholarship with Ottawa’s Jennifer Chandler (14). Most recently, I co-authored an essay in JAMA with Harvey Chochinov on medical aid-in-dying and its relationship to palliative care (15). As chair of the Hastings Center board of trustees, I am honored to work with our president, Vardit Ravitsky, who is Canadian (16). I share these personal connections because they have been incredibly meaningful, and I hope led to important scholarship that we couldn’t have done without expanding our horizons and crossing borders.

These relationships speak to the molecular nature of life. As individual academics, we are connected to each other like atoms within molecules. The bonds are tight, and it is all about relationality and connections that grow stronger over time. It’s no accident that Penfield’s memoir, *No Man Alone* (2), reflected on all those who contributed to a life well led. While I would make the title more inclusive, the sentiment is correct and instructive.

In response to tariffs and other barriers to the free exchange of ideas and scholars, we must reaffirm the strong connections between our two academic communities that the democratic exchange of ideas is a predicate for learning and progress. We must be free to think and collaborate as we choose and do so transnationally, especially with our Canadian friends. Academic discourse between our countries is particularly valuable because we share so many common values but are nonetheless different enough to reflect knowingly on each other’s idiosyncrasies. Each country can provide an outsider/insider perspective on the other. This is immensely valuable in volatile times. And this is precisely what good friends are for.

To neuroscientists, Penfield is best known for his brain mapping. He charted the motor and sensory homunculus which are cortical strips in the brain that are primary motor and sensory cortex, respectively. It was a masterful act of cortical cartography. Both our motor actions and our bodily sensations are processed in discrete provinces or states which correspond to an area of the body.

As a mapper of the mind, Penfield might also have had something to say about the border that Canada and the United States share. I suspect he would see it as a liminal space, one that he traversed personally and professionally, one which both separates and connects, and like the nervous system itself is fully integrated in ways we can yet apprehend. To sever these connections would be to disrupt networks that have taken centuries to cultivate, and which have the potential for further plasticity and growth. Perhaps to stretch a metaphor beyond its membrane, severing these connections would be ablative and akin to the horrors of psychosurgery, a destructive act with enduring consequences. It would evoke changes in our national character, of our personalities, on both sides of the border that we would certainly regret.

Of course, geopolitics is distinct from the body politic, and it is important not to overindulge in analogic reasoning. But just as Penfield’s life and work prompted him to title his memoir, *No Man Alone* (2), his ties to both Canada and the United States might lead to another admonition: “no country alone.” That counsel is especially true when we think of our two countries and the bonds that have served us both so very well.

## Références

1Bliss M. William Osler: A Life in Medicine. New York: Oxford University Press; 1999.

2Penfield W. No Man Alone: A Neurosurgeon’s Life. Boston: Little, Brown and Company; 1977.

JJ. A leg to stand on: Sir William Osler and Wilder Penfield’s “neuroethics.” American Journal of Bioethics 2008;8(1):37-46.

4Flexner A. Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. Bulletin Number Four. New York: The Carnegie Foundation for the Advancement of Teaching; 1910.

W. The Montreal Neurological Institute. Journal of Neurosurgery 1991;75(5):821-22.

6Neurological Biographies and Addresses. Foundation Volume. Published for the Staff, to commemorate the Opening of the Montreal Neurological Institute, of McGill University. London: Humphrey Milford: Oxford University Press; 1936.

JJ. Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness. New York: Cambridge University Press; 2015.

W. Some mechanisms of consciousness discovered during electrical stimulation of the brain. Proceedings of the National Academy of Sciences 1958;44(2):51-66.

ZM, Fins JJ. Penfield’s ceiling: seeing brain injury through Galen’s eyes. Neurology 2017;89(8):854-58.

W. The electrode, the brain and the mind. Zeitschrift für Neurologie 1972;201(4):297-309.

JJ. Neuroethics and the lure of technology. Epilogue. In: Illes J, Sahakian BJ, editors. The Oxford Handbook of Neuroethics. New York: Oxford University Press; 2011. p. 895-908.

JJ. Neuroethics and neurotechnology: instrumentality and human rights. Epilogue. In: Illes J, Hossain S, editors. Neuroethics: Anticipating the Future. New York: Oxford University Press; 2017. p. 601-613.

JJ. Towards a pragmatic neuroethics in theory and practice. In: Racine E, Aspler J, editors. The Debate about Neuroethics: Perspectives on the Field’s Development, Focus, and Future. Berlin: Springer; 2017. p. 45-65.

JA, Cabrera L, Doshi P, et al. International legal approaches to neurosurgery for psychiatric disorders. Frontiers in Human Neuroscience 2021;14:588458.

HM, Fins JJ. Is medical assistance in dying part of palliative care? JAMA 2024;332(14):1137-38.

V. A path forward-and outward: repositioning bioethics to face future challenges. Hastings Center Report 2023;53(5):7-10.