the Natural Condition

“Count something.”

This keen piece of advice comes from Dr. Atul Gawande, as espoused in his most recent book, Better: A Surgeon’s Notes on Performance. Gawande is a general and endocrine surgeon at the Brigham and Women’s Hospital in Boston, MA. Although he is a surgical fledgling, completing his residency in 2003, Dr. Gawande’s insights blossom from his experience in public health issues, at one point serving as a senior health policy adviser for the Clinton administration.¹

The thesis of Better is that, while advances in medical technology, new drugs, and the like can lead to an overall healthier humanity, the most effective — and commonly overlooked — way to improve well-being is to make better use of what we already have. When he proposes that everyone in the healthcare community ‘count something,’ he means that evaluation and reevaluation of current methodology and practice are the true keys to success. We must measure ourselves, and then use those measurements to understand where shortcomings occur. He also makes it gravely clear that all doctors are not created equal in their ability to treat patients.
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The New England Journal of Medicine recently conducted a panel discussion on the issue of Physicians and Execution. The panel members consisted of a general surgeon as the moderator (Dr. Atul Gawande from the Brigham and Women’s Hospital in Boston, a notable author)¹, a law professor (Deborah W. Denno, Ph.D., J.D.), and two anesthesiologists (Dr. Robert Truog and Dr. David Waisel). As individuals who know the science and have researched the ethics behind the topic of execution, one should duly consider their opinions.

Dr. Waisel outlined that the typical lethal concoction consists of 3 drugs. The first drug, sodium thiopental, is a barbituate whose aim is “to put you to sleep, create amnesia and anesthesia.” The second drug, pancuronium bromide, causes muscle paralysis. While anesthesiologists often use both of these drugs to sedate patients in the operating room, the lethal injection doses are necessarily much larger. The third and final drug, however, is not part of a doctor’s toolbox. Potassium chloride Read the rest of this entry »