Kevin O'Rourke Resigns as Director of the Center for Health Care Ethics
Here is a missive that I wrote for our quarterly journal to reminisce about my days in Health Care Ethics. After resigning as director, I spent a month in Ireland to enable Gerry Magill to get his feet under the desk. Then I prepared for our continuing education institutes which are held in May and June. [Kevin O'Rourke]

As I mentioned in a recent issue of Health Care Ethics USA, I am stepping down as Director of the Center for Health Care Ethics. Father Gerard Magill, a priest of the diocese of Motherwell, near Glasgow in Scotland, will be succeeding me as Director, as of January 1, 1999. Gerry, a graduate of the Gregorian University in Rome and the University of Glasgow, has been teaching moral theology at Saint Louis University for about ten years, and has been the director of the Center's Ph.D. program in Health Care Ethics for the past three years. We have worked closely together in developing this program. He was selected to be the next Director of the Center by an interdisciplinary committee of the University and he fills the job description for the position wonderfully well. With Gerry's energy and wisdom, I think the Center will have the far,-sighted and courageous leadership that we need to raise our activities to a higher level, while being faithful to our original mission. While I intend to remain on the faculty of the Center after a vacation in January, (in Ireland, where else) at this time it is difficult not to reminisce about the past.

Many of you may recall, that I came into the field of health care ethics somewhat by accident. After teaching canon law and serving two terms in administration at Aquinas Institute of Theology when it was in Dubuque, Iowa, I accepted a post-doctoral fellowship at the University of Chicago. My intention was to spend a year of study in the area of moral theology with James Gustafson, a noted Protestant theologian, and also avail myself of the presence of my good friend, Richard McCormick, who at that time was teaching at the Jesuit School of Theology, also on the Southside of Chicago. After these studies, I intended to return to the faculty of Aquinas Institute and continue with the faculties of Aquinas, Wartburg Seminary, and the University of Dubuque Theological Seminary, the wonderful ecumenical work which had begun in Dubuque in the mid 60s.

In the course of my sabbatical study year, in January 1973, the United States Supreme Court in the infamous Roe vs. Wade and Doe vs. Bolton decisions, declared that abortion is a constitutional right that could not be prohibited by state or national law. The immediate effect upon Catholic hospitals was one of extreme concern. The Catholic Hospital Association (CHA) realizing that they needed someone to respond to the inquiries that they would be receiving from their constituents in regard to the ethics of abortion and to field questions in response to other ethical issues in health care, started a search for someone to fill this position. My friend Tom O'Meara, O.P., was discussing the search with an official of the CHA and said, "Kevin O'Rourke is available and qualified, but he is destined to return to Aquinas Institute." Well after CHA contacted me, Clem Collins, our Dominican Provincial thought it would be a valuable service for the Church to assist CHA in the field of medical ethics "for a couple of years." The job also appealed to me because it would be a great learning experience and the year or two spent at CHA would give Cletus Wessels ample time to get his feet under the desk at Aquinas.

Tom O'Meara was right about one thing: I was available. But he was wrong as well because I was not qualified in health care ethics. So I had to study day and night in order to serve competently at CHA. Instead of a year or two, I was with CHA for six full years. While I stayed in close contact with the faculty at Aquinas, even teaching summer courses with my friend and mentor, Benedict Ashley, I became immersed in the apostolate of Catholic health care. The matter of abortion did not consume much of my time, because in June 1973, the U.S. Congress passed a law which exempted individuals and hospitals for religious reasons from performing abortions. But the topics of sterilization and Catholic identity did require significant attention. Some of my best friends today are people that I met or worked with during the years CHA.

In the Spring of 1979, Dr. George Thoma, the Vice President of Saint Louis University Medical Center, and Father Ed Drummond, S.J., the President of Saint Louis University, asked me to join the Medical School faculty and start a Center for Health Care Ethics. At the time, most of the 125 medical schools in the country did not have significant offerings in medical ethics so the administration and I were embarking on uncharted ground. Once again my knowledge of a vital topic, in this case medicine, was meager. Hence, I attended rounds in the hospitals and classes in the medical school almost daily for three years.

At first, only June Granville and I constituted the staff of the Center; there were no formal classes or programs but from the beginning we published a monthly essay on ethical issues in health care which still is published today. My favorite memories of those days before Computers were common, are of June enlisting the help of her husband, Jack, to read the essays back ward in order to eliminate typos. About two years after the Center was established, with the help of some "role models and wisdom. figures" on the medical school faculty, the Center was given class hours in the Curriculum of the medical school with the mandate of conducting a required course in health care ethics. Shortly thereafter, we started required courses in the Hospital Administration program, now the School of Public Health.

Over the years, programs, lectures and required classes increased. We now offer lectures or classes in all schools of the health Sciences Center. Several wonderful people that served on our faculty during these years are now serving as ethicists elsewhere. I am tempted to name them all and state their present positions to show how capable they all are, but this reminiscing must not go on for ever.

At about this time, the Central Dominican Province moved Aquinas Institute to the campus of Saint Louis University, where it remains today. During these years of increased academic activity in the schools of Medical Center, we also initiated summer institutes offering continuing education in Catholic health care ethics to people in the Catholic health care apostolate. Under the able direction of Donna Tory and Carlotte Ruzicka, these institutes have become an important part of our mission and are still serving over one hundred health care professionals each year.

It was at one of these institutes that Pat Norris, still looking youthful seven years later, received a nickname that has stuck. A participant from Australia who was summing up the experience of the Institute and expressing thanks for all the participants forgot Pat's name, and when praising his lectures, referred to him as "the young lad." Every time I use that nickname, he refers to me as "the old goat."

The past twenty years have seen development and change in our University and in our Center. But there has also been changes in the type of issue that requires our attention and evaluation. When the Center started, the issues were rather routine and did not require a great deal of scientific knowledge. Thus, we spent much of our time on questions of informed consent, removing life support, observing confidentiality, and proper spiritual care for dying people. Soon after, such problems as brain death and organ donation, amniocentesis, in vitro fertilization, surrogate motherhood and physician assisted suicide came upon the scene. Recently, of course, the issues of cloning and various possibilities associated with the Human Genome Project and genetic intervention have become prominent. Finally the harvesting of stem cells obtained from aborted fetuses and fusing them with cells from a cow is now a reality.

All of these more recent issues require scientific knowledge beyond the quick studies on TV or in the daily press. I admit that I have read one of the standard texts on genes and their behavior more than once, but the information does not stick the way it did ten or fifteen years ago. Hence, I often feel that I am in the wilderness insofar as some of the more recent progress in scientific research is concerned.

In addition to the new issues arising in regard to clinical considerations, there are many social problems which were not considered within the realm of health care ethics twenty years ago. Managed care and methods of reducing the cost of health care immediately come to mind when social issues are mentioned, If medicine takes its social responsibilities seriously, some difficult decisions must be made in the near future in regard to distributing scarce resources. More importantly, adequate access to health care for all citizens is also an acute contemporary ethical issue. The United States is the only industrialized nation that does not have some form of universal health insurance, and as a result, we have some forty million people without adequate access to health care. Whenever someone mentions the excellent health care available in the United States, the best reply is: "Yes, if you can pay for it, and as the care becomes more excellent, fewer people are able to pay for it." In spite of these frustrations, it has been a happy and fulfilling "couple of years." At times, it seems as if I am just getting started. Bless you all.

Kevin O'Rourke, O.P.
St. Louis, Missouri