By KEVIN W. WILDES
April 21, 2006

On August 26, 2005, I began my second year as president of Loyola University New Orleans and welcomed more than 900 freshmen to our campus. It was the largest class in Loyola's history, and 75 percent of the students came from outside of Louisiana.

The following day, I told them, along with all of our other students, that they could leave. And the day after that, I told anyone who remained that they had to leave and go to a Red Cross shelter in Baton Rouge. Later that night, Hurricane Katrina hit New Orleans and the Gulf Coast.

On Monday, August 29, the levees broke and the flooding began. Most of the city was soon underwater, where it would remain for three weeks. Abruptly almost 6,000 Loyola undergraduate, graduate, and law students were scattered across the United States, unable to start classes as planned. Faculty and staff members, many of whose homes had been damaged by the flood, were also dispersed and in need of financial support in terms of salaries and benefits. Fortunately, our students were soon attending more than 500 colleges and universities, and our professors and administrators were paid and receiving their benefits.

Leading a university through one of the greatest natural and man-made disasters in our nation's history has been a full-time job. We had planned well before Katrina. We had off-site computer backup. We had business-interruption insurance as well as property insurance. But no one had imagined the amount and extent of the flooding. I joked with a friend that I kept rereading all my notes from "how to be a president" workshops and didn't find much that was helpful.

Since then people have asked what prepared me to make decisions and lead the institution through the hurricane and the flood. As I have had time to step back and reflect, I have realized that the most beneficial thing for me has been my work in medicine and hospitals, or in bioethicsin particular, clinical ethics.

I have spent my scholarly life reflecting, writing, and lecturing on different areas of bioethics. I have been a teacher, author, and consultant. For example, I have been an adviser at a call service at Georgetown University Medical Center that patients, families, doctors, nurses, and staff members could contact around the clock when they had questions about the ethics involved in various medical decisions. I have worked on many cases where families and doctors are trying to discern their obligations to keep patients in intensive care alive. Among other situations dealing with end-of-life issues, I was involved in the Terri Schiavo case in Florida. I have also dealt with many cases that have concerned informed-consent and treatment issues. Working in hospitals with patients — in emergency rooms, intensive-care units, or on the floor — has been an important training ground for Katrina.

That's because clinical ethics involves what Aristotle called practical reason, and the decisions that I had to make after Katrina were those of practical reason. Practical reason, unlike pure theoretical reason, is applied to a particular set of circumstances and not some fictional world. Practical reason involves making choices and taking action. Practical reason is the process that we undertake with imperfect knowledge, when we must decide what action to take even though we are uncertain about the results.

There are moments and decisions where there is clearly a right thing to do. For example, although medical professionals may disagree with their choices, it is right to honor the requests of competent patients who refuse treatment. Katrina also presented situations that called for what seemed to me to be obvious responses. Some students who had paid tuition to Loyola had to pay a second tuition at another institution. It was clear to me that no one should pay twice, so we refunded their money or applied any payments for the fall to the spring semester.

Yet often in clinical ethics no "correct" answer immediately emerges. Should the patient, who is facing a life-threatening illness, undergo a difficult treatment with an uncertain outcome, or should she let her life end? With Katrina, we also have often had to make judgments without knowing the consequences. In the early days after Katrina, for example, we had to ask ourselves, "Should we pay faculty and staff members when we are unsure of our revenue stream?"

In fact, as in clinical ethics, the decisions of Katrina have frequently been choices between lousy options. In clinical medicine, choices may be between treating a patient surgically, medically (through medication, diet, or lifestyle), or through a combination of both. Each choice may have risks and side effects and no definite promise of success.

In the same way, after Katrina each of our choices usually had both upsides and downsides — and no clear prognoses. The decision to offer an intensified course schedule in the spring was done with the hopes of attracting students back and helping them stay on track academically. But it has brought with it the burden of more work for faculty members, and it was unclear whether it would achieve the desired outcome. In addition, we've had to make some painful choices about our academic programs and restructure our operations to ensure our financial health and better serve our students and community.

My clinical work differed from my leadership of Loyola after Katrina in that I was not the decision maker. I would ask questions, clarify issues, and make recommendations at times, but the patient, family, or guardian would ultimately decide. With Katrina, however, I have been the one making decisions that have and will affect lots of people.

How does one decide and lead in such circumstances? I have relied on my background as both an ethicist and a Jesuit. Facing decisions, I have often called upon one of St. Ignatius Loyola's methods for discernment. I formulate the options and line up pros and cons of selecting each one, recognizing there is no perfect solution. That method has helped me balance the reasons for the different choices and make the best ones that I can.

For instance, when I weighed the options about whether to pay full-time faculty and staff members while the university was no longer in operation, the reason not to pay them was obvious: I had no idea what our revenue would be like, or if we could afford such a commitment. But I also knew that people would need their salaries and benefits, and, if I was to preserve the university, I had to protect the professors and administrators. Without them, there would be no university to which the students could return.

During the crisis, the faculty and staff members were performing heroically. We were maintaining our business operations. We were attending to students' needs. We were raising money. Professors were advising students by phone and through the Internet. In addition, many were using their intellectual talents to meet the crisis. William P. Quigley, a professor of law at Loyola, offered legal assistance to many of New Orleans's most disadvantaged people — for example, helping them protect their homes and deal with other needs. John Biguenet, a professor of English, wrote moving columns in print and online for The New York Times about the plight of the city. It was clear that, just as we had worked to help our students, we needed to support our faculty and staff members if Loyola was to come through the disaster successfully.

That discernment process is a clue to how one leads ethically. In addition, one needs to be as transparent as possible. That is, one needs to be able to explain — to faculty members, administrators, students, and others — why a decision was made. People will often disagree with the judgment. They may have ranked the importance of reasons differently. But at least they can understand the decision. For example, I could explain to the Board of Trustees why I made the decision that I did about salaries and benefits.

Of course, that also means that you need to constantly communicate about your choices, and why you made them, with all the different constituencies of the university. In clinical medicine, the care of patients often involves many different people: patients, physicians, different specialists, family members, insurers. University decisions involve students, faculty members, administrators, parents, alumni, donors, and many others. No one part is "the" university. One needs to lead the whole constellation of communities that make up the institution.

Katrina's legacy will be with us for years to come in its effects on Loyola and New Orleans. We will continue to have to make difficult decisions in the months and years ahead. Those decisions must be made with attentiveness, listening, imagination, and honesty — in short, with keen discernment and an understanding of the fundamental ethical questions that each situation raises.