1939 – 2025
Dr. Thomasine Kushner or Tomi as she liked to be called, Bioethicist at Sutter Health’s Program in Medicine and Human Values and Founder and Editor, Cambridge Quarterly of Healthcare Ethics passed away peacefully on 2/7/25 in Greenbrae, California in the presence of people who loved and admired her. One of the first women to enter the field of bioethics, she was a leader in the field of international bioethics. Her commitment to advancing bioethics through dialogue and creating an international community to address complex bioethics questions was reflected in the several conferences she founded and organized over the years, including the International Bioethics Retreat, Cambridge Consortium for Bioethics Education, and the ICM Neuroethics Network. Tomi was a truly special friend, mentor, and colleague to many in the bioethics profession.
In a copy of her book, Ward Ethics: A Case Book for Doctors-in-Training, gifted to me 17 years ago when I was doing my fellowship training at Sutter Health’s Program in Medicine and Human Values, Tomi inscribed the first page with, “Of all the tools needed by bioethicists: medical facts, skills in analysis, clinical experience, the most critical component cannot be learned – compassion”. As a mentor, I saw Tomi exemplify this quality in every case discussion during my training and after. Being a trained philosopher, it was important to her that the skills of rigorous analysis were applied to each patient care situation that involved an ethical dilemma, conflict, or uncertainty. However, what I learned from her was that the case and the thinking around it didn’t end there. That was when she asked, each time, to reflect on questions of implicit bias, the feelings of the patient/family, how health care professionals were coping with the situation, and the impact of the case on the ethicist. Tomi was always ahead of the times – this aspect of a clinical ethicist’s work was rarely discussed in books on ethics consultation. Reflecting on the experience of all stakeholders allowed me to foster compassion for everyone involved in tough medical situations and appreciate the toll of decision making when navigating uncomfortable muddy waters. It was the compassion she felt for patients and families that motivated her to publish “Surviving Health Care: A Guide for Patients and Families”. Similarly, it was the compassion for residents and physicians that led to “Ward Ethics” and the “What do I do now?” BMJ column.
“Of all the tools needed by bioethicists: medical facts, skills in analysis, clinical experience, the most critical component cannot be learned – compassion”.
She had a knack for turning questions, comments, and discussions into impactful projects. I recall a time early on in my career when we had received funding and been asked by our health system’s top administrator to expand our services to four additional hospitals. Tomi was the first one to propose we build a “Nuts and Bolts: What Hospital Ethics Committees Should Know” toolkit. She was thinking ahead, and the manual co-authored by Tomi, our colleague, Wes McGaughey, and myself, became a prototype for our standardization efforts across the system. When I took on the supervision of our clinical ethics fellowship training, I used the same methodology to then develop a handbook for our fellows. Tomi was hugely influential in my professional development over the course of my career. Her approach to professional growth and mentorship was genuine curiosity and egalitarian relationships. When the outpouring of condolences arrived after her passing, there were numerous physicians and bioethicists who wrote in to share how Tomi had supported them find their voice and build their careers through publications, connections, and mutual exchange of ideas and expertise. Despite her accomplishments and pioneering work in the field, she chose to stay in the background and not draw attention to herself. Never one to impose her thought process or conclusions, she was always just there for anyone who needed a sounding board for topical discussions or professional advice. Even with years of experience in the field, she was committed to continuous learning pondering ways to bring about positive change. She was constantly innovating and applying new methods and tools in an effort to make improvements. These innovations were often at display in the conferences she created and organized over the years to connect the bioethics community worldwide.
Tomi’s impressive career graph included graduate studies at University of Florida and University of Stirling, Scotland, being a faculty member at Florida International University, ethics consultation and bioethics course development at the University of Miami School of Medicine along with co-founding the first ethics rounds and clinical ethics committee for the University of Miami during her time at the Health and Human Values program. In 1985, she joined University of California, Berkeley, as the Executive Officer for the Committee for Protection of Human Subjects and oversaw research ethics. She later served as Clinical Professor of Bioethics in the UCSF/Berkeley Joint Medical Program and as Senior Research Fellow in the Human Rights Center. She served as principal investigator on the first national grant awarded by the U.S. Department of Education to develop curricula in healthcare ethics for hospital ethics committees and was instrumental in the formation of ethics committees at several hospitals. After retiring from Berkeley, she joined Sutter Health’s Program in Medicine and Human Values in San Francisco where she continued to mentor fellows and clinical ethicists shaping their professional development. She continued her work as founder and editor for the Cambridge Quarterly of Healthcare Ethics published by Cambridge University Press.
Tomi contributed extensively to the bioethics literature authoring and editing numerous scholarly articles and books. Some highlights include the “What Do I Do Now?” column for the student British Medical Journal (BMJ Publishing Group), Birth to Death: Science and Bioethics (Cambridge University Press), Asking to Die: Inside the Dutch Debate about Euthanasia (Kluwer Academic Publishers), Ward Ethics: A Case Book for Doctors-in-Training (Cambridge University Press), Surviving Health Care: A Guide for Patients and Their Families (Cambridge University Press), and the most recent Cambridge Elements Series on Bioethics and Neuroethics (Cambridge University Press).
She left us with a legacy to make bioethics better and to keep moving forward with our commitments.
Ruchika Mishra, PhD is the Bioethics Director at Sutter Health, San Francisco.