Founding Gift

Duke University has received a founding gift of $13.5 million arranged by hospice pioneer Hugh A. Westbrook to establish the Duke Institute on Care at the End of Life to improve research, education and practice across the nation for those near death, Duke President Nannerl O. Keohane announced Wednesday.

The new institute will be based in Duke’s Divinity School and will have an interdisciplinary focus with a national and international scope. It is the first academic entity in the country to bring together a broad spectrum of disciplines, schools and professions to look at what has become a pressing social issue: how best to care, as a community, for those in the last stage of life.

Westbrook is chief executive officer of VITAS Healthcare Corp. of Miami, a 1970 Duke Divinity School graduate and an ordained United Methodist minister. He coordinated the gifts from the Foundation for the End of Life Care, the DadeFund of the Dade Community Foundation and VITAS, the nation’s largest hospice provider.

"We are grateful for the leadership of Hugh A. Westbrook and VITAS Healthcare in helping Duke to meet a critically important social challenge - providing humane and compassionate care for those at the end of life," Keohane said. "This new institute is an excellent example of the interdisciplinary strength of the university, linking faculty from our Divinity School with colleagues from across the campus and the nation whose research and expertise can help address the complexities of both living and dying well."

"Duke’s commitment to developing the world’s leading center for the advancement and improvement of care to the terminally ill and their families focuses on one of the most important challenges that can be addressed in human society," Westbrook said. "This generation and all future generations will be able to live a better life knowing that progress is being made on behalf of those we care for at life’s end."

The new Duke institute will involve the full spectrum of professionals who provide end-of-life care, including physicians and nurses at Duke’s medical center, theologians and ethicists from its Divinity School, humanities scholars from its arts and sciences departments, pastors and other caregivers from across the nation, and social work faculty from the nearby University of North Carolina at Chapel Hill.

In addition, the institute is in the process of establishing a formal affiliation with researchers and scholars in the Department of Palliative Care and Policy at King’s College, University of London, and St. Christopher’s Hospice in London, England. St. Christopher’s is widely recognized as the site where the modern-day hospice movement began.

The institute, moreover, will be a partner with one or more historically black colleges in the United States to address issues of particular relevance to the African-American community.

"Issues surrounding end of life care are always significant and increasingly urgent because of changing demographics, economic pressures in contemporary health care, and technological advances tending toward aggressive interventions,"said Divinity School Dean L. Gregory Jones. "In light of these concerns, we need stronger research and improved practice that draws on religious, ethical and socially responsible commitments.

"We are excited about the innovative significance of this new institute," Jones added. "Churches and synagogues have long been leaders in caring for people at the end of life, and Duke’s Divinity School is well positioned to provide leadership in this area. To deal with complex issues involved in dying well, we need interdisciplinary, inter-school and inter-professional efforts. Hugh A. Westbrook’s leadership and founding gifts will enable us to embody our vision for focusing on more effective and faithful care at the end of life."

In earning his master-of-divinity degree at Duke, Westbrook specialized in ethics and pastoral care. For the next 10 years, he served as a pastor in North Carolina and Florida and worked as a hospital chaplain caring for terminally ill patients and their families. In 1978, he co-founded with Esther Colliflower the VITAS Healthcare Corp., which provides hospice care to more than 32,000 patients and bereavement services to more than 90,000 people annually across the nation.

In 1979, Westbrook wrote and was instrumental in gaining passage in Florida of the nation’s first hospice-licensing law and establishing a quality standard for care of terminally ill patients in that state. He has also chaired the National Hospice Education Project, a grassroots effort to promote awareness of hospice care.

Activities of the new Duke institute will include academic research and teaching; practical training for health-care providers, pastors and other caregivers; and public information and educational programs for a wider public.

Traditionally, Duke has moved to address broad societal issues through multi-disciplinary research. Nearly 50 years ago, the university broke new ground in geriatrics research, establishing the nation’s first interdisciplinary Center for the Study of Aging and Human Development. In addition, Duke sponsors the Center for Health Policy, Law and Management through its Terry Sanford Institute of Public Policy. It also conducts the Kenan Ethics Program for the study and teaching of ethics, and has recently established the Center for Medical Ethics and the Humanities in its medical center.

"We anticipate programming for the Institute on Care at the End of Life will include research and education on issues such as theological and medical ethics, cultural diversity and pain management," said Dr. Keith G. Meador, institute director and a psychiatrist on both the faculties of Duke’s divinity and medical schools. "We also are committed to engaging public-policy issues, particularly as they relate to underserved populations. Although the challenges are significant, we believe an interdisciplinary effort is critical to making substantive improvements in practices related to caring for suffering and dying persons."

Meador said he expects the Duke Institute on Care at the End of Life will provide national leadership in training clergy who care for the dying, whether in parish or health-care settings. He also expects the new institute to use hospices across the country to give clinical training to clergy in end-of-life care. In addition, he said, he foresees the new institute serving as a national resource for community and health-care professionals who desire to provide end-of-life care that is attentive to spiritual concerns.

The institute celebrated its founding with a symposium and dinner on Thursday, March 2, at Duke. The symposium, "Opening Doors: Access to Care at the End of Life," addressed the virtues and strength of character needed for caretaking, quality-of-life issues for the dying, a patient-and-family centered model of care, and ways to access care for those approaching death.

Dr. J. Richard Williams, president of the Foundation for End of Life Care and VITAS executive vice-president, said: "In the 21st century, the most important contributions to the health-care industry will come from the work pioneered by those involved in end-of-life care. Duke’s new institute will make a pivotal difference in this care."