In the first installment of his memoirs, Coming of Age, James Semans writes that he was born into a family "concerned not with the material side of life, but with the fact that one gives a service to the society in which one finds oneself."

Throughout his life, Semans rose to the familial challenge. In his professional career, the self-described "doctor of the human condition" pioneered groundbreaking treatments for a range of urological disorders, and also transcended his particular specialty by championing social medicine. He brought a holistic approach to treating the whole person, rather than focusing solely on a particular medical condition, because he genuinely cared about his patients' quality of life.

Semans brought the same notion of compassionate service to his philanthropic and artistic pursuits as well. As one of the original trustees of The Mary Duke Biddle Foundation, Semans served forty-eight years before stepping down as chair and retiring as a trustee emeritus in 2004. He proved to be an invaluable resource for countless arts, educational, and cultural organizations, not just in his leadership role with the Foundation, but in his willingness to offer his own personal time and commitment to individuals and institutions he believed in. His legacy continues in the vibrancy of the North Carolina School of the Arts, the North Carolina State Arts Council, and Duke University's Nasher Museum of Art, among others.

It is possible that James Semans might have fulfilled his family's call to service on his own. But with his marriage to Mary D.B.T. Semans in 1953, a philanthropic power couple was formed. At a ceremony bestowing upon them the North Carolinian Society Award in 1986, Bishop W. Kenneth Goodson encapsulated the collective qualities that the Semanses brought to bear upon their many endeavors:

"Sensitivity, [for] I do not know of any human condition to which they are not sensitive. Compassionate, [for] I have seen this doctor of the human condition and this lovely woman who pleads for compassion go far beyond almost any restraint to give bread to the hungry, water to the thirsty, or a word of hope to the hopeless. Caring [because] I have never seen Mary Semans indifferent to anything good, and I have never known Jim to walk away from any challenge. Loyalty. A complete loyalty to everything that is good and clean and fine."