Tom McCormick, Health and Human Values: Reflections on a Ministry in Higher Education

“Health and Human Values: Reflections on a Ministry in Higher Education”
Thomas R. McCormick, MDiv, DMin.
February 2014

     In 1965, the career pathway that I had imagined for myself was interrupted by an unanticipated fork in the road.   One branch was familiar territory, the other an unknown.   After serving for five years in my first assignment post-seminary as pastor of a small, racially integrated congregation in the High Point community in West Seattle, I was ready to move on.  On one hand, Rev. Loren Lair, Regional Minister in Iowa was inviting me to return to the region where we had become acquainted.  (I had graduated from Drake Divinity School, Drake University, Des Moines, Iowa in 1960)  He claimed that with five years of pastoral ministry under my belt, I was ready to step up and take a rapidly growing suburban congregation in eastern Iowa with a robust budget, a good salary and a new brick parsonage.  He made it sound appealing.  It appeared to be a far cry from our current situation, we had three small children and our family of five was struggling to make ends meet on the low-end salary typical for ministers right out of seminary.  A novice in ministry, I was facing the challenges of holding a disparate congregation together while forging a ministry aimed at serving both halves of the congregation.  Half of our members lived in the High Point housing project, home to approximately five-thousand individuals with low income, many single-parent families on public assistance and elderly citizens whose sole source of income was their monthly Social Security checks.

     The other half of the congregation lived in West Seattle proper, a typical middle-class community, whose citizens had on average a higher level of education and a higher level of employment.  Many were Boeing employees and the average income was four to five times greater than their fellow members on the east side of 35th SW.  With half of our members below the poverty level, we were engaged with what one of our leaders branded as “constant crisis.”  In addition to the usual worship and education opportunities, we also created a pantry to assist those who ran out of food before the end of the month; a large “clothes closet” stocked with used clothing; cooking classes to help moms learn how to use surplus commodities; and a pre-school for four year old children in the project.   On the other hand, Rev. Loren Arnett, an associate minister in the Regional office of the Christian Church in Washington-North Idaho, was inviting me to consider applying for a newly opened position as campus minister at the University of Washington. 

            I must admit that although I knew our church combined their support with other denominations to employ campus ministers at our various state universities and colleges, I really had no idea about what kind of work campus ministers actually carried out.  My only firsthand experience was from my own college days attending Northwest Christian College and the University of Oregon in Eugene, where the campus minister organized Sunday morning Bible study classes and various fellowship events and service projects involving students.

            I resolved to visit the UW campus and talk to students, faculty and a few administrators that I had previously met to discuss what campus ministry might entail in the mid ‘60s.  In hind- sight, my investigation was quite limited, just scratching the surface, nothing profound.  Yet, I began to become intrigued about the possibilities of a kind of ministry that would be very different from the pastoral model with which I was so familiar.  Thus, I applied for the position; I was hired and began my work January, 1966.  My former Iowan mentor was convinced I had made the wrong choice.  When I informed Dr. Lair of my decision, he responded that I was making a grave mistake and that such a move would not further my career in ministry in the least and that he was disappointed not to have me serving a church in the Iowa region.

            For years on the UW campus, the Baptist-Disciple House had served as the home of a cooperative campus ministry devoted primarily to the service of university students from these two denominations.  However, recently, a restructuring brought the United Church of Christ into the mix and a more ecumenical ministry was envisioned as well as various forms of ministry to non-church-related students.  The ministry was renamed the “Koinonia Center” and moved to a newly built structure adjacent to the NW corner of the campus where I joined the senior campus minister, Rev. John Ross, a Baptist.  I began by assisting him in carrying out his existing programs and “learning the ropes,” so that I could cover all the bases the following year when he took a sabbatical year in Japan.  We had a fairly typical program with a Sunday morning coffee hour, followed by a discussion group, after which students dispersed to attend the local churches of their choosing.  On Sunday evenings we offered an ongoing study group examining issues of the day.  On Wednesday evenings local church women provided a fellowship dinner for students which were followed by a guest speaker and discussion.  However, the board of directors had requested that during my first year on campus I should reserve time to explore what campus ministry could or should look like in the future—a challenging proposition.

            In my exploratory year I began an informal investigation into possibilities for new forms and expressions of campus ministry.   I reflected on the current situation where the Presbyterians had their Westminster Foundation, the Methodists had Wesley House, the Lutherans had Luther House, the Catholics had Newman Center, and it appeared to me that all of these centers were providing duplicate services, engaging students primarily from their own denominations in similar opportunities for worship, study, fellowship and service during their university years.  I found myself wondering if it might be possible to form an ecumenical cooperative approach where the current activities could continue, yet be integrated ecumenically rather than segregated denominationally.  Such a move could avoid duplication of effort and free up time and energy to create and engage in new and different forms of ministry.  I suggested this idea to our board (already composed of three cooperating denominations) and found them enthusiastic about such further steps in cooperative ministry.  I also fostered this idea in discussions among the local campus ministers who met weekly for support and limited coordination of effort.  Gradually, our cooperative ministry began to emerge.

            By now I had been appointed by my denomination (Christian Church, Disciples of Christ) to serve as a board representative on a national group called United Ministries in Higher Education (UMHE).   At the national level, Baptists, Disciples, United Church of Christ, Methodists, Presbyterians, and Evangelical United Brethren, had created UMHE to develop programs at the national level that would provide ministries in higher education and to serve as a “think-tank” for envisioning  new forms of ministry in higher education at the local level as well.  I could imagine a similar constellation at the local level involving a “united ministry” at the University of Washington, as well as at the other campus ministries across the state of Washington.  The spirit of ecumenism was strong and by the early ‘70’s, with major assistance from Rev. David Royer (UCC) who joined our staff in the late ‘60’s, the ground work was laid for these major denominations to forge a new ecumenical organization which was named “Campus Christian Ministry” at the University of Washington.  But that is David’s story, and I’ll rely on him to contribute a chapter on this amazing story that led not only to a “common program” but to the purchase of a building that was owned in common, with shared secretarial staff and a united budget, as the other denominational centers around the campus were closed in favor of participation in this ecumenical movement.

            In the meantime, my explorations into new forms of ministry led me into conversations with students, faculty and administrators at the UW, as well as on other campuses.  I chose fifty faculty members at the UW who were considered outstanding in their fields and asked for an interview.  100% of these busy scholars agreed to grant me an hour of their time for an interview.  Primarily, I asked each to describe their work as teachers and researchers, which they did with relish.  They were doing some great things.  For example, Dr. Ted Phillips had recently joined the faculty at the School of Medicine to create a new department, the Department of Family Medicine.  Dr. Belding Scribner was leading the way in providing renal dialysis for patients with chronic kidney failure.  Dr. Donnell Thomas was pioneering bone marrow transplants for the treatment of children with leukemia.  Near the end of the hour, I asked if they could imagine any ways a campus minister could be supportive of their endeavors.  From these fifty interviews, 47 said no, they couldn’t imagine any ways . . . but three faculty members, all from the medical school, said yes.  One said that new developments in medicine were leading to ethical issues and it would be great to have someone lead regular discussion groups for medical students inquiring into these.  A second claimed that in spite of advances in medicine, all will eventually die, and medical students were largely unprepared to deal with dying patients and their families.  A third faculty claimed that although students were taught the physiology of reproduction, there was no instruction in human sexuality and that such an inquiry would be a welcome addition to the curriculum.  Of course, it was understood that these would be non-credit, “extracurricular” offerings.  In all three cases, I was invited by these faculty members to provide leadership for the seminars, while they provided meeting space.

            I found my board very receptive to the idea that I might organize informal study groups on these three topics, and cooperate with faculty in the medical school who had identified such a need.  It had also become clear to me by this time that campus ministry had traditionally been an “upper campus” affair, serving students primarily in the liberal arts.  There was no evidence that a campus minister had previously crossed Pacific Avenue, the dividing point between “upper campus” and entered the domain of the “lower campus” which housed the various health sciences including medicine, nursing, dentistry, etc.  I was happy to forge new trails in this realm of academia and in this part of the campus that had seemingly been overlooked by campus ministers in previous generations.

            In conjunction with my three new faculty colleagues, I organized three discussion groups for medical students.  At noon on Wednesdays we gathered with brown bag lunches in a conference room reserved by the faculty sponsor, who also brought homemade cookies, where I served as convener-moderator for discussions on topics in medical ethics.  We met for the first eight weeks of the quarter, thus respecting the pressures of finals week on student life.  I also formed a discussion group on issues related to death and dying which met in the evening, after the core curriculum had ended.  I was impressed that students would bring a snack and stick around for an additional hour or so at the end of a long day in the “required” class room, for this “elective” discussion.  Thirdly, I organized a seminar on human sexuality, as with the other seminars, of eight weeks duration.  I discovered that over the course of three quarters, some students rotated through all three seminars, while some simply chose one seminar of interest.  Both students and faculty encouraged me to offer these fall, winter, and spring quarters.  The student response to these offerings was robust, and I worked hard to provide background research and reflective questions for our discussions.  The outline of a teaching ministry was forming.

            An unanticipated outgrowth of these seminars was a request from a growing number of students for counseling for various issues. These students saw me as a friendly ally who might help them deal with the stresses of medical school.  Others sought me out because the demands of medical school were creating stresses in their relationships or marriages.  Others suffered from text anxiety or depression.  Some were uncertain if medicine was the right career choice. Many wanted help in choosing which pathway in medicine they were best suited for.  As time went on, nursing students also sought me out for counseling.   I had majored in pastoral counseling in seminary and felt that responding to such requests was a valid part of my ministry.  Sometimes I met students in a spare room in the medical school or nursing school, but most came to the campus ministry center for counseling.  It was clear that my ministry was centering more and more on human values in the “health sciences.”

            When I was hired, the board offered to grant me a sabbatical year for study after I had served for a minimum of five years.  The offer stipulated they would pay full salary for a six month sabbatical or one-half salary for a full year’s sabbatical.  After careful exploration of possibilities, I chose to enter a Doctor of Ministry program at Southern Methodist University (SMU) in Dallas, conjoint with a Fellowship in medical ethics at the Institute for Religion and Human Development at the Texas Medical Center in Houston.  Rev. Kenneth Vaux, PhD., served as director for the bioethics program.  In 1970, Vaux had authored Who Shall Live: Medicine, Technology and Ethics. Just a year prior to my entrance into the program, he had convened an important national conference on “ethical issues in medicine” with lectures from anthropologist Margaret Meade, ethicists Joseph Fletcher and Paul Ramsey, heart surgeon Michael DeBakey, MD, and others prominent in the newly emerging discipline of “bioethics.”  My sabbatical year was one of the most intriguing and exciting years of my life.   In addition to the class work at SMU and the medical ethics seminars in the Bioethics Program in Houston with Vaux, Benedict Ashley, PhD, and Albert Marachewski, PhD, I also sought out opportunities to observe surgery and clinical procedures to become better acquainted with current medical practices.  I watched the famed heart surgeon Michael DeBakey perform a heart valve replacement, I observed electroshock therapy, and I followed primary care physicians in their daily routines of outpatient care.   I continued my studies in the subsequent summer quarters until I completed my dissertation and graduated in 1976 with a Doctor of Ministry with a major concentration in medical ethics, the first graduate in their program with such a major.

            I returned with relish to the campus post-sabbatical in the fall of 1973, bringing fresh enthusiasm and insight for the seminars that had been on hold during my absence.  I was excited to return to teaching and counseling on the Health Science Campus.  My board was enthusiastic about the direction of my ministry and fully supported my work.  I entertained a high volume of requests for lectures on bioethical topics in the local churches and began publishing articles in both the secular and religious press on issues in bioethics.

            Shortly after my return to Seattle after sabbatical, Lane Smith, religion editor for the Seattle Times, published an article one Saturday evening on the religion page entitled “Local minister studies ethics in Texas.”  Lane had interviewed me because he felt my interests in this new field called “medical ethics” would be of interest to his readership.  On Monday morning following the publication of this article, I received a call from Dr. Charles Bodemer, Chair of the Department of Biomedical History, University of Washington, inviting me to meet and discuss our mutual interest in medical ethics.  In our subsequent conference, he expressed a longstanding interest in expanding the department beyond the history of medicine and into contemporary issues in medical ethics.  Our ongoing discussions led to him hire me as a lecturer on a one-third time basis in the summer of 1974 to create elective courses in bioethical topics for the School of Medicine.  Thus, in Fall Quarter 1974, I offered the first formal course in bioethics at the UW School of Medicine.  In August of 2014, I will celebrate 40 years as a teacher of bioethics at the UW.  The name of the department changed, first to the Department of Medical History and Ethics, and more recently to the Department of Bioethics and Humanities, and there are now eight faculty members in bioethics and one historian, Jack Berryman, PhD.

            In the beginning of my tenure at the School of Medicine, all of my courses were electives.  Many of my students, at the conclusion of a course, would comment that “courses in bioethics should be required in medical school.”  One day I discussed with Dr. Bodemer his feelings about requesting a few hours for a required component of medical ethics in the core curriculum.  He was very supportive of the idea, but emphasized that I would need to convince the curriculum committee of the importance of such an innovation.  Subsequently, I was given a spot on the agenda of the curriculum committee where I presented a bit of the history of my bioethics teaching in the elective curriculum and presented a request that I be granted permission to teach an introductory course in bioethics as part of the required curriculum either in the first or second year of medical school.  In the discussion following, the members of the committee, most of whom chaired courses in the required curriculum, spoke strongly of the merit and desirability of my proposal.  I was elated.  Then the chair reminded the members of the resolution that no new curricular hours be added without eliminating a corresponding number of hours of the existing curriculum.  When he asked who might be willing to “give up” a few hours from their course offerings, each and every member protested vigorously that they didn’t have enough hours at present for anatomy, physiology, biochemistry, etc. and couldn’t possibly give up any hours, even for such a good cause. 

            This meeting was my first lesson in “medical school politics.”  Hours in the required curriculum are equated with power in this system, and no one wanted to relinquish that power.  Although I came away feeling discouraged, to my surprise and pleasure, some of these course chairs began inviting me to come as their “guest speaker” to address ethical issues, (of course within the framework of their course.)   Nonetheless, I was pleased at their receptivity and began serving as an invited speaker in several of the required courses in the curriculum, and over the years my contributing hours continued to increase.  Eventually, for example, I was asked by the director of our Introduction to Clinical Medicine (ICM) course not only to provide introductory lectures in bioethics in the first year ICM course, but also to chair a two-day program on “Caring for Patients with Terminal Illness,” for the ICM-II for the entire second year medical school class.  I teamed with an emergency department physician, for many years, to co-lead a tutor group for students in ICM-I, assisting in their formation as professionals.  Thus, my role both in both the elective curriculum and in the required curriculum increased over the years. 

            In the spring of 1980, I did a three month Fellowship in “Teaching in the Clinical Context” at the University of Tennessee, Memphis Medical School Campus, with David Thomasma, PhD, Director, and Terrence Ackerman, PhD and Carson Strong, PhD.  The faculty provided a context for the Fellows to make rounds in several clinical settings each week, in order to discuss ethical issues emerging in that context.  I rounded in the NICU at St. Jude’s Children’s Hospital, in Family Medicine at St. Francis Hospital, in Oncology at the City of Memphis Hospitals, and in psychiatry in the VA hospital.   This Fellowship enhanced my medical terminology and improved my understanding of diseases and their treatment so that I was better prepared to discuss the medical-ethical issues as they arose in a variety of settings.

In 1987, under the leadership of the Department Chair, Dr. Albert Jonsen, we created a week long CME event entitled “The Summer Health Care Ethics Seminar” which has continued for the past 27 years with an average attendance of about 100 physicians, nurses, chaplains, social workers etc., offered the first week of every August.  This acclaimed CME event (Dr. Dudzinski, my co-chair, and I received an award for “Outstanding CME Event-2008,” from Dr. Paul Ramsey, Dean of the School of Medicine) continues to train members of ethics committees and ethics consultation teams from across the country.

            Earlier, I mentioned my incidental involvement as a counselor and sometimes mentor to medical students.  In retrospect, I suppose that my exposure to medical students in our ethics seminars led them to see me as a friendly and supportive individual with a natural interest in their well-being, so that when the going got tough, I was a natural choice for support.  My counseling load increased.  With the support of my board, I envisioned the provision of counseling without any fees as a part of my ministry in the health sciences.   In an unfortunate four year period, there were three medical student suicides.  The death of these students led   Dean Robert Van Citters to appoint a special task force charged with examining “stress in medical education.”  Unbeknownst to me, many of the medical students, when asked by the committee, “what do you do to cope with stress in medical school?” responded, “I go talk with Dr. McCormick.”  Following the committee’s investigation, I received a call for an appointment with Dean Van Citters in which he discussed the work of his committee and then requested that I commence a formal counseling service for medical students, stipulating that my job description and my hours would be expanded.   During these years I was balancing my work as a campus minister, my work as a lecturer in bioethics, and now I was adding a third job description as “medical school counselor.”  I literally had three offices and was working about 60 hours per week; most of my elective courses were offered in the evenings.

            In 1985, Acting Dean, Theodore (Ted) Phillips recognized that a shift was needed and suggested that he hire me as Director of Counseling for the School of Medicine, a full time salaried position.  This arrangement would allow me to continue teaching bioethics (as my time allowed) so that my passion for teaching and counseling could continue to find expression.  At that time, I resigned from what was by then a part-time position on the Campus Ministry staff at CCM so that I could devote my full time to the medical school work.  Somewhat ironically, the work that I had begun, teaching and counseling, as an expression of my campus ministry and funded by the churches, had developed into a medical school faculty position, funded by the university.

            Space doesn’t allow for much detail; however, I would be remiss in not addressing a connection between events at the local and national level.  As mentioned earlier, I was a delegate to the board of United Ministries in Higher Education (UMHE), formed by the commitment of resources and staff of eight major denominations to work in higher education at the national level while providing research and guidance in support of local manifestations of ministries on campus.  Dr. Verlyn Barker was the chief executive officer for this organization and provided committed, insightful and faithful leadership.  One of the programs growing out of UMHE, the “Health and Human Values Program” was a precursor organization to the Society for Health and Human Values, led by Dr. Ronald McNuer.  Another was a group simply called “Ministers in Medical Education.”  I became a member of both groups.  The Society was devoted to larger aspirations such as support for incorporating course work in medical ethics into every medical school curriculum.  At the time I started teaching, the UW was one of only a dozen medical schools that offered formal curricula in medical ethics, as reported by the Task Force for Human Values in 1972.  Today, all 126 member medical schools in the American Association of Medical Colleges (AAMC) have multiple offerings in bioethics.  The Society for Health and Human Values later joined with two other organizations to form today’s American Society for Bioethics and Humanities (ASBH).

The Society for Health and Human Values usually met just before the annual AAMC meetings and of course in the same city.  The Ministers in Medical Education (MME) group came a day earlier and members spent time sharing reports of their teaching ventures in the various medical schools across the country.  Here I should mention that many of the earliest contributors to medical ethics were theologically trained and were thus more comfortable with what was then called “applied ethics” than were students from typical philosophy departments, who were more interested in issues related to meta-ethics.  Ideas shared in the MME conferences often led to the formation of new ethics electives in the medical schools served by these innovators. 

Through the MME group I met Rev. David Duncombe, PhD.   Although well known in recent years for his 40 day fasts to bring the attention of congress to bear on problems such as world hunger and starving children, or nuclear disarmament, at that time he was Yale Medical School’s first chaplain.   He recounted for us how in his first year at Yale he was asked by the gross anatomy instructor to be present in the human dissection labs as a way of supporting students in this transition from layperson to medical-professional.  At the end of that first year, he led a memorial service with students, honoring the cadavers from whom they had learned so much about human anatomy.   He became so knowledgeable about anatomy that the course chair appointed him to serve as a teaching assistant in the course, a role he continued for many years.  He left Yale to serve as chaplain to the medical school at UCSF where he continued until his retirement.  Interestingly, some years later, Daniel Graney, PhD, head of Washington State Willed Body Program, and UW professor of anatomy asked if I would conduct a memorial service for the families of the donors to his program.  For over a decade, I conducted such a ceremony for those who had donated their bodies and accompanied the families to a local cemetery where the UW had a burial plot with a vault containing the ashes of approximately one hundred donors each year.  There were many stories like David’s and mine from ministers who had a role in teaching bioethics in medical schools in those early days, before departments of philosophy reached a turning point and began preparing doctoral students in bioethics who now populate the departments charged with teaching bioethics in medical schools. 

 In today’s world, prepared as I was then with an MDiv. and a DMin. there is small likelihood that I would be offered a job in medical education.  However, forty years ago, I was at the right place at the right time and a door opened where I could be of service.  I found a niche in academia that felt right and good and I’ve never looked back nor had any regrets about following the path that opened before me.   There is a large ripple effect in patient benefit from our work in encouraging the professional development of ethically trained, compassionate physicians who are willing to devote themselves to the service of the sick and suffering.

I now have first and second year medical students who approach me on the first day after class and introduce themselves as the son or daughter of a mom or dad who had been in my ethics classes a generation earlier, claiming they had received parental instruction, “You’ve got to take McCormick’s ethics class!”  Many of my former ethics class students are now in key positions of leadership, serving as clinicians, on medical school faculties, and as medical directors in hospitals.  I have had wonderful opportunities to mentor graduate students and junior faculty members.  I’ve enjoyed contributing to the body of medical ethics literature through many publications.  I’ve been able to provide lectures for professional societies across this country and participate in invited lectureships in Canada, German, Italy, Taiwan and Japan.

One somewhat humorous postscript to my personal story follows.  In 2000, at my wife’s encouragement, I stepped down to a 40% position at the UW, with the intent of transitioning toward retirement.  My wife’s family all live in Phoenix, Arizona, and our plan was to spend winter quarter in the sun and to spend time with her family.  Through a variety of coincidences, after being invited to provide a lecture in bioethics at Midwestern University Medical School, Glendale Branch, I was invited to become an adjunct professor of bioethics in that school where I have taught a three credit elective on various bioethical topics every year since 2001.  Further, in discussions with the Dean of Students at the medical school shortly after arriving, he was inspired by learning of the counseling services that I had helped pioneer at the UW.  He invited me to take a position on his staff where I became the first medical school counselor at Midwestern—a job that I agreed to take only to get the program started, and after working at 50% time for four months,  subsequently hired my replacement.  As I started that winter quarter in Arizona, teaching bioethics and counseling medical students, my wife quipped, “Congratulations McCormick, you didn’t really retire, you just replicated your UW positions in Arizona!”   

In conclusion, from the perspective of forty years in the field, it is clear that major changes have occurred in medical education.  Currently, all of the medical schools participating in AAMC, as well as most of the osteopathic medical schools across the country are offering either required or elective courses in bioethics.  Residency training programs incorporate ethics conferences as a staple in their curricula.  Bioethics is an important component for continuing medical education (CME) programs for physicians in practice.  National Institutes of Health (NIH) now requires that doctoral students in the sciences, particularly those that might use human subjects in research, participate in required ethics training.   Across the USA, hospitals have developed ethics committees charged with resolving conflicts, teaching ethics and providing ethics consultation.  The Joint Commission (TJC), formerly known as the Joint Commission on Accreditation of Health Care Organizations (JCAHO) has made ethics committees in hospitals a requirement for accreditation.  The American Society for Bioethics and Humanities (ASBH) is serving as a major contributor to the establishment of norms for evaluating the competence of ethics consultation services.  The Report of the ASBH, entitled  Core Competencies for Healthcare Ethics Consultation, 2011, is now in its second edition. One can anticipate that such efforts will stimulate ethics consultants to engage in continuing education and will most likely lead to the certification of those providing such services so that standards of competency remain high.  Even in the face of these positive developments, much work remains to be done.  Our citizens must become educated, not only in the role of individual choices toward healthy living, but also in the importance of social determinants of health so that changes can be made at the systemic level to improve the health of our nation.   Finally, the principles of justice and  of respect for persons imply that every person should have access to decent health care.  I am pleased that local campus ministers contributed to these changes.  The church should acknowledge that organizations such as United Ministries in Higher Education had a creative hand in supporting such changes, and those programs at the national level, such as the Health and Human Values Project, played an important role in fostering work toward a better future.

 

 

 

           

 

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