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<p>Mark Fox, MD, PhD, MPH, and Joseph Kotva, PhD, share details on the Ethics, Equity and Justice Scholarly Concentration, which&nbsp;<span style="color: rgb(51, 51, 51);">provides medical students with the basic skills for separating the morally beneficial from the morally troubling practices of medicine.</span></p>

In their words: Scholarly Concentration Q&A with Ethics, Equity and Justice co-directors

map shows the location of the ethics, equity and justice concentration in south bend

In 2019, IU School of Medicine launched Scholarly Concentrations. To help students decide if a concentration topic is the right fit, concentration co-directors shared the inside scoop—from why they got involved in the concentration to how a specific topic can help students reach their goals.

Topic: Ethics, Equity and Justice
Location: South Bend
Co-Directors: Mark Fox, MD, PhD, MPH and Joseph Kotva, PhD

Introduce yourself. Who are you and why did you decide to become involved in this Scholarly Concentration topic?

Mark D. Fox, MD, PhD, MPH: South Bend’s Scholarly Concentration in Ethics, Equity, and Justice offers an opportunity to integrate my professional and academic interests. I am a physician, ethicist and public health professional. My MD/PhD was non-traditional; my PhD is in Religion, Ethics, and Society, and throughout my program, I had the opportunity to serve as an ethics consultant for the Vanderbilt Transplant Center. My dissertation and much of my academic work have focused on ethical and policy issues in organ donation and transplantation. On the other hand, my clinical work as a Med/Peds physician and preventive cardiologist has focused on care for vulnerable and underserved populations, from a cardiovascular risk reduction program for uninsured adults to a street outreach clinic for homeless youth. During my fellowship, I was also able to complete a Master’s in Public Health which provides an additional skill set to address social determinants of health and health disparities.

Joe Kotva, PhD: My narrative includes living in the Bronx for five years while I pursued a PhD in theological ethics, focusing on virtue ethics, with a minor in medical ethics. That biography also includes being an urban, Mennonite pastor for 10 years and being married to a nurse for 35-plus years. I spent several years volunteering at a soup kitchen, and four years working with people who have significant cognitive disabilities. I still spend many hours sitting on sidewalks and curbs, chatting with homeless men, women, and children.

These aspects of my history illustrate the forces that taught me to think about health care in terms far broader than the patient-physician relationship or various ethical principles. These experiences taught me that morally-worthy medicine has more to do with moral formation than it does with principles or quandaries or formulas for calculating right actions. These experiences also informed me that health care involves many relationships, roles and institutions, and that what makes for health is more tied to where you live, the color of your skin and your education and income than it does with the time you spend in a physician’s office.

These aspects of my history also hint at why I am so excited to be involved in a Concentration that focuses on Ethics, Equity, and Justice. We will work through typical medical ethics material, including principles, difficult choices at the beginning and end-of-life and the questions that come with scarce medical resources and new technologies. However, we also get to work together at the more important, if seemingly mundane, matters of virtue, narrative, justice and the environmental and social determinants of health. We also get to think together about where medical students and physicians fit within this matrix of forces and how we can be agents for change toward a more morally-worthy health care system.

Tell us about your experience related to the concentration topic.

Fox: Given my educational and professional background, I have had a range of experiences that are relevant to the Ethics, Equity, and Justice concentration. Yes, I have had significant experience as a clinical ethics consultant. I’ve served as an ethics committee member for hospitals, organ procurement organizations, and the national Organ Procurement and Transplantation Network. I’ve also served as an Institutional Review Board member, as well as in other policy and oversight functions. Over the past 15 years, my work (both clinical care and research) has increasingly focused on improving access and outcomes for vulnerable populations, as well as attending to the moral, ethical and policy considerations arising in these contexts.

Kotva: My PhD is in theological ethics, and much of my academic career has focused on the intersections of virtue ethics, narrative ethics, justice, and medical ethics. I’ve been teaching medical ethics in various settings for 25-plus years. I ran a small medical ethics center for four years (where much of our work focused on health care reform). I’m the co-editor, with M. Therese Lysaught, of On Moral Medicine: Theological Perspectives on Medical Ethics, a standard textbook in many seminaries and church-affiliated colleges. I have a decade of experience sitting on hospital ethics committees. I have done related consulting work with churches, retirement communities, ethics committees, and finance/investment institutions. For the last decade, I have co-chaired the Healthcare Ethics Interest Group for the Society of Christian Ethics. Currently, I co-direct, with Dr. Fox, the Summer Community Health Innovation Program an eight-week, hands-on, program that brings together undergraduates and medical students around themes in community health/social determinants of health.

What are you most excited about in regards to Scholarly Concentrations and your concentration topic?

Fox: I am excited about the breadth of exposure students will gain in the Ethics, Equity, and Justice concentration. Students can explore ethical dilemmas to inform their own practice or to equip them to serve on an ethics committee. The concentration is great way for students who are interested in epidemiology or community based research to better understand health inequities. Additionally, for students who are drawn to care for underserved populations by a commitment to social justice, participation in this scholarly concentration will help them in that professional trajectory. The other feature of the Scholarly Concentration in South Bend is the access to mentors from the med school, Notre Dame and other community partners who are engaged in and committed to a broad spectrum of topics that fit within this concentration.

What are the three most important or interesting things students should know about this concentration?

  1. Ethics is relevant to all medical specialties
  2. Ethics is much more than rare, headline-grabbing moral quandaries; it involves an entire range of concerns from seemingly mundane, everyday matters that we usually fail to notice to larger structural issues of justice and equity.
  3. The South Bend community offers unparalleled access to teachers, scholars, and researchers in the field who can serve as mentors to students in the concentration

How is this concentration beneficial to a student’s personal and professional goals?

The concentration will:

  1. Challenge students’ preconceived notions of ethics and justice and how these concerns apply to Western health care
  2. Inspire students to attend to matters of moral formation and to creatively engage issues of social justice, especially as related to health and health equity
  3. Equip students to serve on various ethics committees

Some students may have a hard time deciding which concentration to choose. How can a student decide if this topic is the best fit for them?

This program is particularly well-suited to students who:

  • Wrestle with our society’s enormous social and health inequities
  • Recognize that the practices of medicine are morally formative of physicians and patients alike, often in worrisome directions
  • Value theological and philosophical moral reflection on their future profession, including everyday and morally puzzling activities
  • Want to serve on ethics committees.

What are the special resources and expertise on this concentration’s home campus?

In addition to the two co-directors, we have two faculty members with extensive experience in medical ethics. Kathleen Eggleson, PhD, has developed case-based ethics curriculum and has an interest in the moral questions that arise with powerful new technologies. Gary Fromm, MD, teaches a course on film and medicine at Notre Dame and has extensive experience serving on a hospital ethics committee.

We also have access to numerous Notre Dame faculty eager to serve as mentors to students in the concentration. We also have working relationships with Notre Dame’s Center for Social Centers, Reilly Center for Technology and Values, and de Nicola Center for Ethics and Culture. We likewise have working relationships with various community partners, such as the Center for the Homeless, DePaul Academy, La Casa de Amistad, Youth Services Bureau, and the St. Joseph Department of Health.

What is the academic and social culture life on the home campus?

Being adjacent to and affiliated with Notre Dame includes obvious advantages ranging from cultural and academic enrichment to exciting collegiate sports. The broader South Bend area provides access to various parks, the St. Joe River, community events and a minor league baseball team.

You provided some examples of potential projects for this concentration. Can you also provide some more details and examples of what one or two different projects could look like?

The range of potential projects is as wide as is ethics itself. A more theoretical project could focus on moral questions that arise from synthetic biology or how we should evaluate the recent claims by a Chinese scientist to have used CRISPR to edit babies genetically. A project could focus on how one or two specific medical specialties tend to both attract and shape physicians into specific character traits, and how we should evaluate those traits. A project could look at the moral significance of friendship and how to sustain morally worthy friendships within the demands of modern medicine. A hands-on project could evaluate the specific risk-distribution of lead poisoning or other environmental hazards within South Bend and efforts to remediate those risks. A project could even address health care’s oversize role in climate change by engaging/evaluating a healthcare system’s efforts to reduce its carbon footprint.

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
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