- Editors' Note
Women represent just over half of the US population yet comprise only 20% of the U.S. surgical workforce. Some of the challenges that women surgeons face, such as objectification and pay inequity, are tantamount to those that many women workers face. However, women surgeons face additional unique challenges that go largely unnoticed and often are ignored. The symposium in this issue, "#MeToo in Surgery: Narratives by Women Surgeons," includes 12 stories from women who share their experiences in the field of surgery related to gender, gender discrimination, bias, and sexual harassment.
The symposium editor, Pringl Miller, MD, FACS, is a general surgeon trained in hospice and palliative medicine and in clinical medical ethics. She is an Assistant Professor in the Departments of Internal Medicine and Surgery at Rush University Medical Center and a founding member of Time's Up Healthcare. Dr. Miller was extremely dedicated to this topic and to disseminating the call for stories. As a result, we received an excellent response to the call for stories, and are able to share an additional seven narratives in the online supplement.
Peter Angelos, MD, Ph.D., FACS, Patricia Dawson, MD, Ph.D., FACS, Jennifer Griffith, Ph.D., and Kelsey Medeiros, Ph.D., provided three commentaries for the symposium. The commentary authors are experts in surgery, organizational behavior, healthcare equity, and medical and surgical ethics.
As the primary care physician shortage grows in significance, research has suggested the possibility of nurse practitioners filling the gap of care. Elena M. Kraus, M.D., discusses this in the research article included in this issue titled, "An Exploratory Analysis of US Nurse Practitioner Perspectives on Training and Credentialing." There are no empirically established quality or safety concerns when nurse practitioners (NPs) practice independently, and no data to suggest that they provide better care when supervised by a physician. NP training programs have expanded, and, as a response to the ever-growing wealth of scientific knowledge and complexity of care, the American Association of Colleges of Nursing (AACN) endorsed efforts to make the standard of NP education a doctoral degree. NPs have faced opposition from some physician groups over expanding their care. The author shares perspectives from 15 NPs on their education and clinical training, focusing on particular questions about professional roles and inter-professional relationships.
"Even irrational choices of decisionally capable patients must be respected, but if a patient is not able to determine what is in his or her best interests, or if the patient's choice is coerced, our ethical obligation to respect the decision is reduced." Lori A. Roscoe, David P. Schenk, and Joel L. Eisenberg explore this consideration in their case study, "Forcible Amputation in Delusional Patients: A Narrative Analysis of Decisional Capacity." The case demonstrates a situation in which two patients, both with cognitive impairments, are asked to make a choice between two undesirable courses of action—to undergo an amputation in order to stop the spread of fatal infection or choose not to amputate, which [End Page v] will likely cause the patients' deaths. The cases end with very different outcomes and raise questions about the role of decisional capacity in informed consent.
The Special Article in this issue, "Optimizing Community Bioethics Dialogues: Reflections on Enhancing Bi-directional Engagement on Health Care Concerns," was written by Jerome W. Crowder and Peggy L. Determeyer. Community Bioethics Dialogues (CBD) is a small group-oriented qualitative research method not unlike a focus group, with the dual purpose of providing researchers with information about a community of interest while educating and empowering participants to create change in their communities. The method is reminiscent of town hall forums that allow for "deliberate democracy" through community discourse. The dialogues for the study discussed in the Special Article took place in Galveston, Texas with six groups of elderly residents from diverse communities. The first topic of discussion was Patient-Centered Outcomes Research (PCOR) and Comparative Effectiveness Research (CER). The group was facilitated by one of its own, chosen by the other members and then trained and supported by the researchers. After the CBDs, the researchers encouraged the participants to continue the conversation...