Editors' Note

We are pleased to publish the second issue of volume eleven of Narrative Inquiry in Bioethics (NIB), which was supported by the Open Society Foundation. The Open Society Foundation has made mental health one of their priorities, working "to ensure that people … who experience mental health challenges can live free of discrimination and stigma." We thank the Open Society Foundation for their generous support.

In this issue, we aimed to collect international stories exploring ways of living with mental health challenges that go beyond treatment with pharmaceuticals. The issue includes 12 personal narratives by people who have navigated mental health challenges and describe a wide range of responses. James M. DuBois and Heidi A. Walsh served as the symposium editors and wrote the call for stories with helpful input from Christine Ogaranko, a Senior Program Officer at the Open Society Foundation. There are three commentary articles on these narratives by experts in cultural and international psychiatry and psychiatric epidemiology, refugee mental health, and human rights advocacy. The commentary authors are Dainius Pūras, Linda B. Cottler, and James K. Boehnlein and Mark Kinzie.

The research article in this issue, entitled "Crying with a Patient: A Pilot Study of the Attitudes of Physicians and Physicians-in-Training," was written by Danielle Brazel, Julia Witowska, Michael Wesolowski, and Emily E. Anderson. Physicians, who often must relay difficult news about death, a poor prognosis, or failed treatments, are taught to maintain emotional distance, but there is some evidence that many physicians and trainees have cried in the hospital setting in response to the emotional stress of the job. In this research article, the authors used vignettes and closed- and openended questions to explore the attitudes of medical students and physicians to understand their views about displaying emotion in front of patients.

The case study in this issue was written by Laura Specker Sullivan, Mary Adler, Joshua Arenth, Shelly Ozark, and Leigh Vaughan and is titled, "Shared Decision-Making in Palliative Care: A Maternalistic Approach." This article introduces a new dimension of the shared decision-making spectrum: maternalistic decision-making. In the case study, Mrs. M is on a ventilator and continuous dialysis in the ICU with multiple organ failure and no improvement. Her sisters act as her surrogate decision-makers, and their church-centered religious lifestyle prevents them from making decisions that would interfere with what they perceive as a "natural death." They want to "do everything" that might help their sister improve, though it soon becomes clear to the medical team that no improvement is possible. The authors use Alexander Kon's continuum of shared decision-making to describe the various decisions made in the case, from patient-driven (strict autonomous) decision-making all the way to physician-driven decision-making. In the case study, the medical team uses maternalistic decisionmaking when presenting strong recommendations to the family—to remove the sister from dialysis, and to choose between two code status options that would allow for natural death, in accordance with the family's wishes.

This issue of NIB includes a narrative education report, "Responsibility for Structural Racism in Medicine: Reflections and Recommendations from One Institution." Authors Laura Specker Sullivan, Dante Pelzer, Alexandra Rice, Yuri Karl Peterson, Robert M. Sade, Danyelle M. Townsend, Leigh Vaughan, Michelle Nichols, and Nancy Zisk describe their experience engaging as a small group of scholars in a Medical Ethics Forum Fellowship focused on race and ethnicity in 21^st century health care. Over multiple sessions, the authors developed introspection on individual responsibility for structural racism. By digging into their institution's history, the authors discover a painful and troubling past and discuss their own agency in altering its future.

News about Narrative Inquiry in Bioethics

The NIB Foundation was established in 2010 to foster education and research in bioethics and related fields through publishing and other activities. The education tab on the NIB website contains abstracts of all previously published cases studies with discussion questions, a guide for facilitating narrative discussion groups, and two sample narrative discussion group handouts, "Exploring Stigma and Bias in the Care of Patients: Stories from Patients" and...