Volume XIV, Number 2 Omaha, Nebraska Fall 2004

When the Center for HealthPolicy and Ethics decidedto produce a report to

mark the 20th anniversary of theCenter, faculty and staff searched forjust the right metaphor to describewhy we are together, who we are andwhat we do. We settled on a metaphoralready strongly established atCreighton University, “Anchoredin Ethics,” to which we added,“Reflecting Jesuit Values.” Accordingto Lakoff and Johnson, metaphors aremore than just a characteristic oflanguage.1 Metaphors not onlyinfluence how we think but what weexperience and how we act as well.The “anchor” metaphor was richenough to describe the history anddevelopment of the Center for HealthPolicy and Ethics, one of the onlycenters of its kind in the nation thatfocus on the practice of ethics andpolicy issues.

Moreover, metaphors highlightcertain aspects of an idea, concept orimage and hide others. The anchormetaphor highlights security or safetyin that an anchor does not allow aboat to drift. So our work in ethics andhealth policy does not drift far fromthe Jesuit values that anchor us towhat is important. We are secure inthe Jesuit teachings and Catholictradition of Creighton, which iscommitted to teaching, scholarshipand service to others, promotion ofjustice and the betterment of society.

The anchor metaphor encouragesus to reflect on our past leadershipnoting the impact and guidanceof the first two directors, CharlesDougherty, PhD, now president ofDuquesne University in Pittsburgh,Pennsylvania, and Ruth Purtilo,PhD, now chair of the Ethics Initiativeat the Massachusetts General HospitalInstitute of Health Professions inBoston.

An anchor is also a symbol of hopein the Christian tradition2 . The workof the Center is “hope-full” in threemajor areas: 1) contributing to theformation of ethically committedhealth professionals; 2) advancing anethic of service, justice and compassionfor others; and 3) fostering intellectualexchange in solidarity with thehuman community.

As the Center seeks a new director, wehave the opportunity to pull up

anchor and move forward undernew leadership. We could not safelyembark on this new phase of theCenter’s life without due preparationfor the voyage. Our past leadershiphas provided us with excellentdirection and vision in a sea ofuncertainty in health care. We aresecure in the values that anchor us tothe mission of Creighton University.In the interim, the Center willcontinue to work on projects thatclearly reflect Jesuit values suchas interdisciplinary scholarship,dialogue with those closest to theimplementation of health policyand the delivery of health care andcollaboration with the health sciencesschools to shape the ethical practicesand decision-making of future healthprofessionals.

If you have not received a copy of the20th Anniversary Report and wouldlike one, please contact Chris Karasekat ckarasek@creighton.edu or 402-280-2017.

1 Lakoff, G. and Johnson, M. 1980.Metaphors We Live By. University ofChicago Press, Chicago, IL.2 Ferguson, George. Signs and Symbolsin Christian Art. Oxford UniversityPress, New York, 1961, p. 169.

Amy M. Haddad, PhDInterim Director

ahaddad@creighton.edu

INTERIM DIRECTOR’S REPORT

A Time for Reflection and Moving Forward

CHPE 20th Anniversary Report

In October, Ruth B. Purtilo, PhD,departed CUMC’s Center forHealth Policy and Ethics. During

her ten year tenure, Ruth made manysubstantial contributions to theCenter, to Creighton University, tothe School of Medicine, to Omahaand to Nebraska.

Ruth led the Center in its efforts tokeep the ethical and humane aspectsof medicine and health care in theforefront of the public policy debate.She has been a tireless advocatefor those who cannot speak forthemselves, campaigning forequality in health care distributionto marginalized populations, bothurban and rural, in the U.S., andinternationally.

Ruth combined her passion for ethicalissues in chronic illness, long-termcare challenges and end-of-life carewhen, in 2001, she led an internationaldialogue addressing major ethical andscientific concerns about the diagnosisand prognosis of Alzheimer disease.These dialogues resulted in the book,Ethical Foundations of Palliative Care forAlzheimer Disease, to which severalCreighton faculty members madecontributions.

Ruth’s new position at MGH Instituteof Health Professions, an affiliate ofMassachusetts General Hospital, isa natural extension of her interestin persons with disabilities. She willdevelop an ethics fellowship andscholarship program as a part of acenter that highlights caregiver ethicalconcerns and will integrate it withclinical, research and academicprograms within the PartnersHealthCare System.

With Ruth’s leadership, the Centerfulfilled its goals to ensure that ethicalramifications are considered by healthcare public policy makers throughnumerous roundtable discussions,clinical ethics series, lectures andspecial events. Ruth Purtilo has set

the stage to ensure patient’s rights arenot forgotten in the rush to reform thehealth care delivery system.

I am pleased that Ruth will continueher formal affiliation with CreightonUniversity and the Center. She hasbeen appointed Clinical Professor ofHealth Policy and Ethics in the School

of Medicine. This appointment willfacilitate her ongoing collaborationwith the Center for Health Policy andEthics.

Ruth leaves CHPE in the capablehands of Amy Haddad, PhD, interimdirector and professor in the Centerfor Health Policy and Ethics, andprofessor in the School of Pharmacyand Health Professions. Amy has beenwith Creighton for 20 years, mostrecently serving as associate directorof the Center .

As we wish Ruth well in her newendeavors, we remain committedto the Center’s mission dedicated tothe study and teaching of ethicaldimensions of health care and healthpolicy consistent with CreightonUniversity’s Catholic and Jesuitvalues.

Cam E. Enarson, MD, MBAcenarson@creighton.edu

It’s Hard to Say Goodbye New CHPE Book on Justice and Jesuit Health

Sciences Presented toSuperior-General Father

Kolvenbach SJ

“As I witnessed health care inHaiti, it became apparent thatpoverty was inextricably linked tothe unnecessary suffering of somany Haitians from preventableand treatable diseases such astuberculosis, malnutrition,HIV/AIDS and many others.”Rachel Bognet is presently amedical student, but these are herwords as a senior undergraduatestudent at Scranton University,one of the 28 Jesuit universitiesand colleges in the US. A relativelynew hallmark of Jesuit highereducation is its focus on justice.As Father Kolvenbach, superiorgeneral of the Society of Jesus,emphasized in his 2000 addressat Santa Clara University, Jesuituniversities are to form “men andwomen for others,” concernedabout and able to effectivelyparticipate in the struggle againstsocial injustice. “Jesuit universitieshave stronger and differentreasons than many other academicand research institutions foraddressing the actual world asit unjustly exists and for helpingto reshape it in the light of theGospel.”

This is aformidablechallenge inits own right.But it is everthe moreformidablefor Jesuitmedicalcentersbecause the literature on Jesuithealth sciences education is verysparse. Nevertheless, CreightonUniversity Medical Center hasdeveloped several uniqueeducational programs on justiceeducation. Notable examples arethe Institute for Latin AmericanConcern, which offers many

Cam Enarson, Amy Haddad andRuth Purtilo at a Roundtable.

continued on back page…

According to a UN reportissued in July 2004, a recordnumber of 4.8 million new

infections of HIV were documentedfor the last year. Only one in fivepersons has access to preventionprograms. Half of all newly infectedpeople between the ages of fifteen andtwenty-four were female, and amongall people with HIV/AIDS, half are

women. Moreover, women areincreasingly vulnerable given theirstatus in many geographic areas andwithin different cultures. Exploringthe meaning of the epidemic for us inOmaha seemed a timely decision.

Dr. Marion Field Fass, professor ofbiology at Beloit College in Wisconsin,made the Women and Health presen-tation. She was a participant in theGlobal Partners Project in 2002, acollaborative effort between theAssociation of American Collegesand Universities and African Womenin Science and Engineering. Throughextended visits to Kenya andTanzania, Dr. Fass worked withuniversity teams to develop curricula

for undergraduate courses onHIV/AIDS, plan activities to involvestudents in HIV/AIDS activities oncampus and develop communityoutreach programs implemented byuniversity staff and students.

“The interrelationship among manyfactors affects a disease epidemic,”claimed Dr. Fass. Her analysis of theAIDS epidemic began with her premisethat knowledge of biology and publichealth were insufficient to understandthis epidemic. Information fromeconomics, public policy, sociologyand anthropology all contribute todeciphering this problem, for manyfactors increase the likelihood thatone might contract the virus.

Vulnerability to HIV is an especiallyimportant issue for women. Her workin Africa convinced Dr. Fass of twomajor points: all people but especiallywomen need to have access toinformation about this disease andits prevention, and women musthave the ability, and often financialindependence, to make decisions thatare in their best interests. Although thestatistics can be depressing, Dr. Fassconcluding on a more positive note,suggested numerous actions membersof the audience could take.

Winifred J. Ellenchild PinchRN, EdD, FAAN

wpinch@creighton.edu

Deciphering the AIDS Epidemic: A Report on the 15th Annual Women

and Health Lecture

Not only has Gary Westerman, DDSCHPE Associate, been inducted as aFellow in the International College ofDentists, he will also receive the 2004Milagro Award. This award is givento honor outstanding contributors in“making a world of difference in thelives of our patients,” by Omaha’sOneWorld Community Health Center.Congratulations, Gary!

Congratulations

Heartland Delta IVConference

The visit of Father Peter-HansKolvenbach, SJ, superior generalof the Society of Jesus, highlightedCreighton’s Jesuit-lay partnershipwith its opportunities andchallenges. The Heartland DeltaIV Conference gathered some 500members of twelve Jesuit collegesand universities with this samegoal of networking aroundcommon interests and of clarify-ing the sense of lay formationin Jesuit institutions.

Jack DeGioia, president ofGeorgetown University, sharedhis personal journey as a layperson trying more fully toincorporate Ignatian values in hislife. He described the challengesof integrating his spiritualand professional growth witha “straining of vocabulary” toarticulate what this meant tohim as a lay person.

Father Greg Boyle, working withat-risk, gang-impacted youngmen and women, emphasizedthat “kinship” should be our wayof life and that judgment can’tco-exist with compassion. Hisphrase, “God is in the mess,”urged us to vision as God does -seeing the circle with no onestanding outside — not merelystanding for the right causes, butalso standing in the right place.

My hope is that Heartland DeltaIV will have lasting effects amongits attendees and that continuingdialogue, kinship and the call tobe women and men for and withothers will allow us to touchthe hearts of those we meet atCreighton, in the communityand across the Heartland Deltaregion.

Helen Shew, MBAProgramming and Community

Relations Coordinatorhshew@creighton.edu

CHPE Bids Farewell to Director Ruth Purtilo

It only takes one meeting with Ruth toknow and understand that respect for thetalents and contributions of the group —the entire group — is central to her work.She frets over every last detail of “goodmanners” as well as the critical elementsthat are necessary for moving a projectforward. When I reflect on what I havelearned from and with Ruth, I believe itcenters on “learning” and the power ofthe learning community present in CHPE.Jerome Bruner proposed the followingcharacteristics of communities of learners:generative content; active learning; reflec-tive thinking and practice; collaboration;passion and community. Ruth’s leadershiphas facilitated the development of a stronglearning community at CHPE consistentwith these characteristics. She may beleaving Creighton, but the learning andcollaboration will continue.

Gail JensenAssociate Dean

Pharmacy and Health Professions

I have fond memories of working withDr. Purtilo for the past 14 years.Many ethical issues occur within ourspecialty of obstetrics and gynecology.In the clerkship, we would present aclinical ethics case, and our studentswould work through it. In thatparticular case, we engaged in roleplaying as husband and wife. I learneda great deal from doing this exercisewith Dr. Purtilo! It was interesting tosee how each clerkship was differentand how the feelings among thestudents varied widely. It truly was avery, very positive experience for me,and I will miss that as Ruth moves onto her new position in Boston. She wasalso very helpful to me personally inhelping me work through medicalethical issues that sometimes occur inobstetrics and gynecology. I wish Ruthall the best in her future endeavors.

Alfred Fleming, MD Chair, Dept. of Obstetrics & Gynecology

I met Ruth at a bar. She was impressed that I had developed a taste forgreen chartreuse. Good conversation followed — Ruth loves goodconversation.

Deeply committed to Creighton’s Jesuit mission, Ruth invited me to givepresentations on God and suffering at the Center’s workshops — and Ibelieve she actually read my book, Finding God in Troubled Times.

Ruth soon designated me the Center’s “chaplain,” an honor involving asolemn obligation to give a blessing at the Center’s annual Christmaslunch and gift exchange.

Over the years I grew to admire Ruth’s unique blend of humanness andprofessionalism — this lady remains at the top of her field.

We shall miss Ruth much. I remain comforted knowing she will continueto make our world a better place in her new position.

God be with you, Ruth! You remain in our hearts and prayers.

Richard J. Hauser, SJRector of the Jesuit Commuity at Creighton University

“Chaplain” for Center of Health Policy and Ethics

We at Creighton will miss the person and specialgifts of Dr. Ruth Purtilo very much. Ruth’s sense ofservice to the Creighton community was expressedin words and deeds – especially in her work withwomen’s groups in the Metro-Omaha area.

But Ruth’s sense of service and focus went farbeyond Omaha. She schooled herself – as a trueprofessional – with resources and ideas from theUnited States as well as Europe and Africa. Ruthcould look at issues from different perspectivesand bring her unique vision, common sense andwisdom to challenging situations.

Ruth is a woman who loves a challenge and this iswhat she seeks: the next challenge. But knowingRuth, the next challenge is only a “next.” Shewill have many more. Best success, Ruth, in thechallenges that lie before you. Thanks for spending11 years with us. We will miss you!

Pat Callone, MA, MREVice President for Institutional Relations

An avid gardener, Ruth’sdesk almost always has abeautiful bouquet of freshcut flowers from herown garden.

Known for losing her eyeglasses, she often carriestwo pairs. Once her glasseslay on the table of ourResource Room for overa week; after severalannouncements aboutthese “lost glasses”someone else recognizedthem as Ruth’s.

Ruth and her husband,Vard Johnson, have aFrench poodle namedCassie who has “guarded”CHPE during manyworking-weekends.

When Ruth was at theU of Minn getting herundergraduate degree shediscovered a new thumbmuscle in the hand of araccoon.

How

Well D

o You Know

Ruth Purtilo?

Center for Health Policy and Ethics2500 California PlazaOmaha, Nebraska 68178

Address Service Requested

FacultySarah CurrierWinifred J. Ellenchild PinchCam EnarsonBeth FurlongMark GoodmanAmy M. HaddadGail M. JensenJudith Lee KissellRichard L. O’BrienRuth B. Purtilo

-Contributed Service

Non-Profit Org.U.S. Postage

PAIDPermit No. 227

Omaha, NE 68178

Linda S. ScheirtonJos V. M. WelieGary Westerman

StaffMarybeth GoddardChris KarasekHelen ShewGina SvendsenKate Tworek

Book Presented toKolvenbach SJ

continued from page 2…

health sciences students a wonderfulopportunity to help relieve the needsof patients in the Dominican Republic,the country neighboring Haiti onthe island of Hispaniola. Anotherexample is a course for second yearmedical students about the “SociallyMarginalized Patient.” This coursewas developed under the directionof, and first taught by, Dr. RuthPurtilo, the immediate past Directorof CUMC’s Center for Health Policyand Ethics.

More information about thesetwo programs, the Haiti programdescribed by Rachel Bognet, and avariety of similar projects at differentJesuit universities in the US andabroad, can be found in a new book,entitled Jesuit Health Sciences and thePromotion of Justice: An Invitation to aDiscussion, edited by CHPE membersJos Welie and Judith Lee Kissell andpublished by Marquette UniversityPress. The projects described areinspiring, the accompanying articlesthought-provoking, the photographsmoving. The book is an importantstep in the direction of educating menand women caregivers for others.

Jos Welie, PhDjwelie@creighton.edu

Taking ApplicationsCreighton University is seekingnominations and applications for theposition of Director of the Centerfor Health Policy and Ethics (CHPE).Candidate applications shouldbe sent with a letter addressingqualifications, a curriculum vitae andthe names, addresses and telephonenumbers of three individuals whohave agreed to provide letters ofreference to: Dr. Gary H. Westerman,Chair of Search Committee, CreightonUniversity Medical Center, School ofDentistry, 2500 California Plaza, Omaha,NE 68178. Women and minoritycandidates are encouraged to apply.Creighton University is an EqualOpportunity, Affirmative Actionemployer.

Creighton University Center forHealth Policy and Ethics is seekingapplications for a Senior VisitingFellow during 2004-2005. Duration ofthe fellowship is three to six months.Applicants should have nationaland international recognition and asustained record of contribution inbioethics or related fields. Specialconsideration is given to applicantswhose areas of research and otherscholarly activity complement theon-going work of the Center. Fellowsare expected to be in residence for theduration of their stay and to engage inselected service or teaching activitiescompatible with their interests and the

New FaceCHPE is pleased toannounce KateTworek as the newestmember of the Centerin the role of facultyadministrativeassistant. Kate comesto the Center with awealth of administrative, technicaland corporate training experience.She taught computer programmingat Metropolitan Community Collegefor over ten years and was nominatedfor Metro’s Teaching Excellence Award.Kate is married with three collegeaged sons, and in her spare time,enjoys cooking and reading.

FOCUSFOCUSFOCUS is published twice a year in the spring and

fall by Creighton University Medical Center’sCenter for Health Policy and Ethics

2500 California Plaza, Omaha, NE 68178Telephone (402) 280-2017.

Editor . . . . . . . . . . . . . . . . . . . . . . Amy Haddad, PhDAssociate Editor. . . . . . . . . . Judith Lee Kissell, PhDDesign and Layout . . . . . . . . . . . . . . Gina Svendsen

Center’s needs. Stipend available.For further information contact: AmyHaddad, PhD, Creighton University,Center for Health Policy & Ethics, 2500California Plaza, Omaha, NE 68178.Phone: 402-280-2164, email:ahaddad@creighton.edu.