In Memoriam: Remembering Dr Leonard Ortmann: Public Health Ethics Teacher and Mentor

The public health community has lost a valued and impactful leader in the field of public health ethics. Dr Leonard Ortmann, a brilliant and outspoken ethicist, died on May 4, 2023, after a three-year battle with cancer. He served as senior public health ethics consultant at the Centers for Disease Control and Prevention (CDC) from 2010 until days before his death. Leonard focused on translating his theoretical ethics knowledge into practical tools for public health professionals to apply to their daily work. Through his commitment to serving as an educator and mentor to countless public health professionals, Leonard’s legacy will continue long after his death.

Leonard W Ortmann, PhD

Leonard earned a bachelor of arts degree in philosophy in 1976 from Yale College and a doctorate in philosophy in 1990 from the Pennsylvania State University. As part of his dissertation research on the relationship between science and values, Leonard was a Fulbright Scholar, conducting research at Ruhr University in Bochum, Germany. After completing his doctorate, he taught philosophy and logic at Conception Seminary College in Missouri. He then taught at St John’s College in New Mexico as part of an innovative program that integrated humanities and science curricula and facilitated student-centered learning in science, mathematics, and humanities courses. In 1999, he began work at Tuskegee University as an assistant professor of philosophy and in 2006 became senior associate for programs at Tuskegee’s National Center for Bioethics in Research and Health Care. While at Tuskegee University, he taught courses on philosophy, medical ethics, bioethics, research ethics, and logic. He was a member of the Bioethics Shared Resource in Tuskegee’s Cancer Grant Partnership with the University of Alabama at Birmingham and the Morehouse School of Medicine. The activity he enjoyed most was coaching Tuskegee University’s Intercollegiate Ethics Bowl Team, teaching participants to examine and analyze difficult ethical challenges, providing them with a space to practice deliberating respectfully, and preparing them for the national competition sponsored annually by the Association for Practical and Professional Ethics.

Leonard initially came to CDC in 2008 to serve as the first and only CDC–Tuskegee University senior public health ethics fellow. This 2-year fellowship was designed to promote the study and application of ethics in public health practice and research. During his fellowship, Leonard worked at the National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), where he provided support to CDC staff as an ethics consultant, analyst, and trainer. During this time, he collaborated with NCHHSTP sexually transmitted disease researchers to develop an ethical rationale for advocating for public health programs on expedited partner therapy for chlamydia.

Leonard began full-time work at CDC in 2010 and continued working until just before his death. He served as a senior ethics consultant within CDC’s Office of Science. In this position, he worked across CDC, providing ethics consultations and teaching CDC professionals about the importance of identifying and managing ethical dimensions of their work.

Practical Public Health Ethics

Leonard had a deep personal commitment to everyday ethics—not just big, news-making topics but also to those fundamental decision-making challenges that public health professionals face every day. His perspective and practical application of ethics influenced the culture of CDC. Leonard’s focus on the practice of public health ethics transformed CDC’s internal Public Health Ethics Committee. He translated his deep knowledge of philosophical ethics into practical wisdom, which he shared generously. He made frequent presentations to the Public Health Ethics Committee on various public health ethics topics, providing commentary that helped members understand and infuse ethical theory into their ethical analyses. Through his accessible tutelage, members of this committee grew more confident about their ability to apply public health ethics considerations to their work at CDC.

Leonard made ethics accessible enough to see it integrated into many public health ethics consultations across CDC’s programmatic, preparedness, and emergency response work. He remained committed until the very end, providing input on numerous current issues, including data ethics and the use of artificial intelligence, appropriate public health uses of identifiable private information, and treatment of patients with mpox. His service on the Institutional Biosecurity Board and Gift Review Panel at CDC was evidence that practical ethics touched nearly all aspects of CDC’s work. His work as cochair of the CDC Emergency Operations Center Ethics Desk meant that emergency response leadership at CDC had ready access to input on ethics issues during activation of the Emergency Operations Center. He provided ethical input on many CDC responses, including H1N1, Ebola, Zika virus, and COVID-19. In addition, he assisted CDC with its preparedness efforts relating to pandemic influenza and nuclear/radiation events. His work played a prominent role during the COVID-19 pandemic when CDC considered the ethical dimensions of the response, including the acceptance of monetary and nonmonetary gifts to support CDC’s work on the pandemic.

One topic about which Leonard was particularly passionate was the infamous study “United States Public Health Service Study of Untreated Syphilis in the Male Negro, Macon County, Alabama,” ¹ currently referred to as “The US Public Health Service Untreated Syphilis Study at Tuskegee,” ² which was conducted during 1932-1972. The study unethically withheld effective treatment from Black men with syphilis for decades. Leonard was part of a workgroup dedicated to acknowledging the 50th anniversary of the end of the study. His ethical perspective was key to the success of what became one of CDC’s largest events, reaching nearly 4500 people in person and online. During the presentation on November 30, 2022, Leonard provided insights not only into how and why public health professionals started this “study” but also how oppressive racist beliefs and systems enabled it to continue despite major ethical violations. He reflected on the ethical violations that harmed the men of Macon County and their families during the 40-year study. In part, Leonard said, “In almost all of these research abuse cases there are almost always great differences between the researchers and the people who are being studied. The researchers are usually White, they are well educated, have higher social status. The people who are being studied are often poor, uneducated, belong to a minority [group].” Without academic jargon, Leonard reminded us of the core, underlying health equity issues that were profoundly violated during the study. Ultimately, the men who were part of the syphilis study had 2 requests: that they not be forgotten and that something like this would never happen again. Leonard’s life’s work helped ensure that their requests were honored.

Educator and Mentor

More than any other role in his work as a public health ethicist, Leonard enjoyed and excelled at his role as a teacher and mentor. Whether it was a quick chat in the hallway or an extended, spirited debate during a discussion about a sensitive public health action, Leonard was eager to connect the ethics dots for his public health colleagues. Even a quick email to Leonard could generate a timely and insightful response worthy of printing and filing away for reference and safekeeping.

In addition to teaching CDC staff, Leonard was a sought-after presenter for trainings and conferences. He made presentations to numerous university students and public health practitioners from across the country. He was an engaging speaker—thought-provoking and at times controversial. He spoke about topics such as ethical considerations for public health surveillance and ethical issues relating to reproductive health. Whatever the topic, he always provided an excellent introduction to the field of public health ethics.

During a period of 13 years and in various settings, Leonard trained more than 1200 public health professionals. His training focused on ethics, but he also helped his colleagues learn to think critically about public health issues. His students—and we were all his students—learned, for example, about the distinction between bioethics and public health ethics, how ethics and law complement each other, and the important interaction between science and values. He served as a mentor to numerous interns at CDC and provided public health ethics training to student interns from Tuskegee University. He also influenced public health practitioners outside of CDC through his numerous workshops at public health conferences and his service as a peer reviewer for scientific journals and meetings.

In addition to efforts to build public health ethics capacity at CDC, Leonard worked to build capacity among external partners. One important effort was his work with the National Association of County and City Health Officials to build public health ethics capacity within local health departments. He helped to develop an ethics training program for use by state and local health officials, and he worked diligently to ensure that the training materials were kept current. In addition, he provided input to the Public Health Accreditation Board as they considered the development of standards for public health ethics, shared his expertise with the American Public Health Association Ethics Section for their work to update the Public Health Code of Ethics, and worked with colleagues at Emory University to teach public health personnel to use the Brokered Dialogue method ³ to encourage public dialogue across contentious public health issues.

Leonard made 2 additional lasting contributions that will serve to teach public health professionals now and in the future. He co-edited 2 open-access books on public health ethics, Public Health Ethics: Cases Spanning the Globe ⁴ and Narrative Ethics in Public Health: The Value of Stories, ⁵ published by Springer Press in 2016 and 2022, respectively. In addition, for both books, he wrote critical chapters, which serve as practical teaching tools accessible to all public health personnel. These books embody Leonard’s contributions to public health ethics in that they were not dry, theoretical discussions but real-world situations meant to teach and spur discussion of ethical principles as they apply to the hard work of public health.

Final Thoughts

As the field of public health grows increasingly complex due to advances in technology, the datafication of nearly every aspect of our lives, and persistent social divides, all of us in the trenches of public health practice will need Leonard’s wisdom and practical perspective on incorporating ethics—what we should do and why—into our work. It was our honor to learn from Leonard, and we now can honor him through carrying on his commitment to teaching, mentoring, and ensuring that all that we do is guided by ethical reasoning in addition to data and evidence.

We were privileged to work with Leonard. His passion for discussion of ethical theory and philosophy was infectious and helped us do our best work. He welcomed any ethical question, always willing to engage in deep, ethical discussion. Although his responses could be complex at times, it was obvious that he gave each question a thoughtful and personal response. But not all conversations with him were deeply philosophical. Often, they veered into such quotidian topics as household repairs, which he enjoyed both doing and complaining about, or his favorite ice cream spot, where he could be found on many summer evenings sharing an everyday pleasure with friends and his wife. Most importantly, Leonard was a pleasure to be around. He was caring, interested in others, and had a clever wit. He enjoyed telling a good story that would always leave us laughing. We are grateful for the time we shared with him. Rest peacefully, friend.