Editor's Commentary

“And now for something completely different…” is probably what the Editor thought when he saw the first version of the manuscript by Gansera et al. Not because it was as grotesque as Monty Python's first feature film in 1971, but because it was really, really different. And interesting. And controversial. It took a lot of editing and several phone calls and more editing to come up with the result which is published and still not perfect, but the quintessential core of the first draft is still there: the “open questions” in the last paragraph. The authors were unable to come up with conclusions, and this is why they were skipped. The article is about observation and discussion. It does not fit into the fixed pattern of an original article, so a new format was created, which is now put to the test. The questions, originally strewn in at the various case descriptions, were condensed and put at the very end with the distinct message: Please think about them and discuss!

Apparently, the manuscript was the product of an ethics project at L.S. Gansera's medical school. When she visited her mother's workplace, she observed several amazing cases over a relatively short time and tried to summarize her impressions. The Editor wanted to have the paper from the start because the issues of concern are well known to all of us and have been topical for a very long time.[1] [2] They are inconvenient—this is probably why they are brushed aside whenever they resurface. But they are bound to stay, which is why an open discussion is so important.

In agreement with the reviewers and the authors, the Editor invited four primary discussants, who were thought to have distinct opinions, and luckily everybody agreed promptly. Article and commentaries were tied into a bundle, which is now presented to the readers to get the debate going with a clear appeal: Take some time to reflect the ethical issues raised for your own practice, and maybe even participate in this discussion and voice your opinion. Surgery is a very human thing and we love it for all its humaneness and fallibility. Whatever your view, bear in mind H. L. Mencken's provocative verdict that “there is always a well-known solution to every human problem—neat, plausible, and wrong.”[3] Such is life, but it often helps to think about it.

Your contributions in the form of a Letter to the Editor are eagerly awaited under https://mc.manuscriptcentral.com/tcsurgeon. Thank you.

• References

• 1 Heinemann M, Borst HG, Frank G. Heart surgery in an HIV-positive patient: experience with a double valve replacement. AIDS Forsch 1988; 8: 454-457 (AIFO)
• 2 Hust MH, Metzler B, Ebermann F, Heinemann M, Ziemer G. Trikuspidalvalvulektomie bei antibiotikarefraktärer Rechtsherzendokarditis. Dtsch Med Wochenschr 1997; 122 (4) 80-85
• 3 Mencken HL. The divine afflatus. New York Evening Mail. New York, NY: November 16, 1917