New today

On Ted Talks Clint Smith has a thoughtful message about the danger of silence.  He says that “silence is the residue of fear…who has to have a soap box when all you ever needed was your voice?”  So what does this say to me and to any other hesitant whistle blowers out there?  We have to speak up, our voice has to be heard and we need to support each other to conquer that “residue of fear”.

Prisons were prominent in another 2 presentations on the web this morning.  Dan Pacholke gave a moving presentation also on Ted Talks about the necessity of giving prisoners meaningful lives.  Even though incarcerated, there are constructive things that can be done.  In some prisons, prisoners are participating in scientific experiments, in others, they are involved in gardening.  There was a time when prisoners were not allowed to work because that was considered some kind of coercion, so they had to sit around and contemplate their navels.  Recidivism is bound to be reduced if prisoners have a meaningful skill when they get out (and most of them do).  Is this something for the integrity watch to be concerned about?  Well, yes.  Ex-offenders that don’t have meaningful lives wind up re-committing, wind up shooting people who wind up in hospitals, wind up getting shot themselves.  What goes on in our prisons impacts on all of us.

Even more moving was the blog on Medpage Today by Joel Zivot, MD, an anaesthesiologist who had the unsettling experience of witnessing an execution by lethal injection.  The event itself would turn the stomach of almost every caring individual but what bothered Dr Zivot the most was that 2 physicians were on duty in the arena itself.  An attendant fainted and, rather than rushing to his/her aid as any doctor is trained to do, they held back.  In our Core Curriculum at the New Jersey Medical School, we have a module entitled “Ethics, Humanism and Professionalism”.  There are 4 tenets for Ethics: 1. Autonomy 2. Beneficence 3. non-maleficence and 4. justice.  In that death chamber, autonomy had been lost to our prisoner long ago.  He was permitted a few last words of apology but that was all; and justice, well, justice was justice, not for medical doctors to decide.  These 2 were out of the hands of the 2 physicians standing by.  But what of beneficence and non-maleficence?  The very core of what medicine is all about?  Dr Zivot questions the appropriateness of the presence of physicians in that  chamber of horrors.  Have they violated their oath?