The Park Ridge Center has partnered with Michael Reese Health Trust to launch an initiative on Judaism and health care ethics, a project to enable Jewish health care providers and patients to question, discuss, and draw conclusions about health care ethics, healing, and spirituality from a Jewish perspective.

Mandel Clinic, the West Side Dispensary of Michael Reese Hospital, c. 1900

Fortunately for human-kind, care for the poor is among the many great traditions of the Jewish faith. Historically, this has often meant caring for "our own." This was a primary motivation of the Jewish philanthropists who founded Michael Reese Hospital in 1879. No less important was securing an environment to train Jewish physicians denied admitting privileges and access to medical education elsewhere. While the days mandating this latter need have passed, care for the vulnerable remains our collective responsibility. Immigrant needs are no less pressing today than in the late 1800s—only the balance of ethnicity has changed. We reflected on this history as we crafted the grant-making guidelines for Michael Reese Health Trust, the successor foundation to Michael Reese Hospital.

From Hospital to Health Trust
Michael Reese Health Trust is a "conversion" foundation. When a not-for-profit entity is sold to a for-profit corporation, the charitable assets (the purchase money and the endowments of the hospital) must remain within the charity stream. Supervised by the attorney general and guided by a cohort of stewards selected as its trustees, the resulting foundation has the responsibility to perpetuate, to the degree that it can, the mission and vision of its predecessor institution and respond to the charitable needs of the general public. These conversions can come about through sale, merger, joint venture, or corporate restructuring. They are usually precipitated by the increasing uncertainty and competition in hospital management and the decision of trustees to salvage assets for community benefit. Conversion foundations vary tremendously in their asset size, organizational structure, and mission.

The asset base of Michael Reese Health Trust is modest in comparison to those of later conversions, $78 million (approximately $50 million at the time of the sale). The law requires an annual minimum distribution of 5% of the fair market value of the assets and the requisite percentage of excise tax. Turning to the hospital's history for directives on how to direct these charitable assets, priorities were established: continue to look after our Jewish needy and faithfully respond to the needs of the community's underserved, paying particular attention to immigrant populations. The trustees also made a conscious decision to de-emphasize the funding of scientific research.

By the date of the sale of the hospital and the 250,000-member staff HMO in 1991, and certainly by the time private foundation status was established in 1996, hospital after hospital across the country had closed or sold. Faith-based institutions, in particular the relatively small number of Jewish hospitals, had become increasingly scarce. The picture is even worse today. In Chicago, Mount Sinai Hospital and Medical Center is the city's only Jewish hospital. In most cities the uniquely Jewish hospital has passed into history.

Implementing the Vision
The trustees spent a good deal of time consulting with Chicago's city leaders and health care providers. We worried about how best to apply the available dollars, how to keep covenants with the permanent endowments that had been entrusted to us, how to position the Trust to respond in a timely manner to emerging issues, and how we might affect public policy to bring about systemic change. Further discussions considered how to avoid agency dependency on our support and how to help organizations build capacity to sustain their work well beyond our participation.

In addition to all of this, there were other troubling questions. With the sweeping changes in health care, the disappearance of Jewish hospitals, and the effects of assimilation, what does the physician miss by not having an opportunity to "check in" with Jewish colleagues—to balance medical practice with the tenets of the Jewish faith? Is there a void in the absence of such a resource? Does this change the care, or the perception of care, for the caregiver or for the recipient? If so, how so, and how can we address this void?

Representing staff and trustees who appreciate cultural appropriateness as a necessary ingredient of care and healing, believing that the mezuzah over the door brings comfort and meaning to the faithful who struggle for strength, and after many discussions with physicians, rabbis, and caregivers, we felt emboldened to initiate a conversation with the Park Ridge Center to further this discussion.

This issue of the Center's Bulletin is devoted to the issues raised by our questions. We look forward to the thoughts and debate it will provoke. We remain committed to anchoring the responses in our future grant making, and to carrying the messages from this study to the medical community at large.