Editors' Note.

Abstract

Editors' Note James M. DuBois, Ana S. Iltis, and Heidi A. Walsh This issue marks the end of NIB's tenth year in operation. We are pleased to publish the final issue of volume 10 of Narrative Inquiry in Bioethics (NIB). The symposium includes 12 personal narratives by people who have navigated challenges with discharge from hospitals. Elizabeth Pendo, the symposium editor, along with members of the NIB editorial staff, wrote the call for stories and invited three commentary authors, Beth Prusaczyk, Kristi Kirschner, and Lisa Iezzoni. Dr. Prusaczyk is an implementation scientist who specializes in improving healthcare for older adults and other vulnerable populations by understanding how to better implement existing research findings into real-world practice and policy. Dr. Kirschner is a physician who specializes in physical medicine and rehabilitation and has a particular interest in disability issues and marginalized populations. Dr. Iezzoni is a medical researcher who conducts health services research focusing on healthcare experiences and outcomes of people with disabilities. The research article in this issue, entitled "A Qualitative Study of the Views of Individuals With Type 1 Diabetes on the Ethical Considerations Raised by the Artificial Pancreas," was written by Ariane Quintal, Virginie Messier, Rémi Rabasa-Lhoret and Eric Racine. An artificial pancreas is being developed to automate and simplify the management of type 1 diabetes, which requires regular blood glucose measurements and tailored insulin administration. The artificial pancreas raises psychosocial and ethical issues that could impact its uptake, despite its clinical benefits. The authors conducted semi-structured interviews with people with type 1 diabetes and characterized various psychosocial and ethical issues with the artificial pancreas using a thematic analysis approach. In general, participants were in favor of the artificial pancreas, despite having highlighted key ethical considerations, specifically control and empowerment in care; identity and relationships; safety, security, and cybersecurity; public and private coverage; patient selection criteria; and consent in research. The researchers concluded the study with suggestions to add functionality to the pancreas to allow for user autonomy (such as the option to suspend infusions), and improve the design and aesthetic of the pancreas (a concern that disproportionally affected the women interviewed). To foster its success, the considerations raised need to be addressed in the development of the artificial pancreas and in clinical practice guidelines and coverage policies. The case study in this issue was written by Anji E. Wall, Liza Johannesson, Giuliano Testa, and Ann Marie Warren, and is titled, "Two Cases of Pregnancy Following Uterine Transplant: An Ethical Analysis." As the number of uterine transplants increase worldwide, a common narrative of critique has been that the benefits are not worth the risks—that the pregnancy will be so unlike a "normal" pregnancy that it will not satisfy the recipient's wishes. Reasons given include that the pregnancy will be highly medicalized (with frequent tests to manage the higher risks), and that the mother will not be able to feel movement of the fetus or contractions because of detached nerves, thus creating a feeling of estrangement from both the organ and the child. In this case study, researchers conducted [End Page v] in-person interviews with two uterine transplant recipients in the United States. The purpose of the interviews was to gain a fuller picture of the benefits of gestation after uterine transplant, so that those benefits can be weighed against the risks more accurately. Both women reported that they "felt" pregnant, experienced many common pregnancy symptoms, and felt the baby move during their pregnancy. Both experienced bonding with their child during the pregnancy, and credited their pregnancy will encouraging nesting and preparation for the child's arrival. Overall, the differences inherent in gestation after uterine transplant did not detract from the value each parent placed on her pregnancy experience. 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 NIB website includes a section on education, which contains abstracts of all cases studies with discussion questions, a guide for facilitating narrative discussion groups, and two sample narrative discussion guides, "Exploring Stigma and Bias in the Care of Patients: Stories from Patients" and...