An Open Letter to Atul Gawande MD, MPH: Your Ethically Unhinged Medical Utilitarianism with an Empathy Facade
Dr. Gawande,
Congratulations on your selection as the “cost-cutting” CEO of the new Healthcare initiative by Amazon, and friends.
Of course, my personal enthusiasm is quite tempered by the fact of our past interaction at the Brigham and Women’s Hospital (BWH) surrounding the morcellation disaster in women’s health — and the catastrophic harm that was done to my family and others’ there. An institution where you were one of the leading voices for patient safety whom I approached in the first several weeks after the magnitude of the hazard was clarified to Dr. Amy Josephine Reed and me.
Not only as a general surgeon, but as a public health advocate and patient safety leader at BWH, you failed to rise up, at all, to defend a surgical and ethical critique and position you knew was absolutely correct — I know that your silence was for the sake of internal politics, or perhaps it was because of the ethically imbalanced utilitarian philosophy your writings seem to promote.
Maybe you too believe that the majority benefit and cost/revenue advantages somehow justified the minority subset of women whose cancers were being spread and upstaged by GYNs using their “meat-grinders” through small holes.
You will recall that only after the battle had been won did you opine on social media about the morcellation hazard in gynecology— only to remove your comments upon my sharp critique given the opportunistic appearing timing of your posts after-the-fact, and because you had without a doubt failed to do the right thing as a surgeon and public health leader. The record of our communications exists and has been presented to the court as part of ongoing litigation.
Dr. Gawande, I recognize that your written words are quite eloquent and that we live in a world ruled by smooth words and fake facades, more dominantly than by strong actions — but actions or lack thereof, when real moments of leadership arrive, speak far more clearly than a thousand sweet words in pretty books that buy Harvard professorships and CEO titles….and, that, is “What Matters In The End”!
Of course, I and others, recognize most your policy positions to be dominantly driven by politics (locally) and by utilitarianism (systemically). The trouble being that in your exercise of these forces you do not seem to be ethically constrained at the level of the individual patient.
To be sure, despite the empathic public image of a polished Harvard professor and surgeon, your complacent silence regarding the morcellation disaster in women’s health (and all its root causes) at BWH and elsewhere in gynecology, is a seriously concerning litmus test — a binary one, which you failed.
I predict that in your new position of power, you will drive policies that will neglect minority subsets of patients for the presumed “benefit of the majority” — under the rubric of well-marketed concepts like “Quality of Life” or “End-of-Life Care” or “Length of Stay” and other concocted notions designed to “cut costs”.
But can society as a whole dictate the meaning or value of any specific amount of time needed or earned for any particular citizen using dollars and cents? Do we really want to devolve into such a state?
I can tell you that as my wife earned every minute of every day, at massive dollar cost, with our children, and achieved a radically unexpected amount of meaningful time — the value was not quantifiable, nor would most ethically unhinged utilitarians like yourself consider it feasible or justifiable.
You see Dr. Gawande, cost-cutting and revenue enhancement in healthcare delivery is very possible using utilitarianism — because implicit to it is accepting the sacrifice of minority subsets for the benefit of the majority.
Your writings and the complacent behavior I’ve observed from you, demonstrate that you are poised to reveal the power of utilitarianism using your newly acquired corporate powers — if only we do away with the ethics of responsibility to the individual patient and to potentially expendable minority subsets of patients, whose choices and time on this earth are highly personalized aspirations.
So forgive me when I say, on the record to all who know Amy and my family’s battle for public health, that your selection as CEO of a powerful new Healthcare initiative in America is monumentally frightening — much more so because you are so convincingly empathic and soft-spoken in your ethically lax utilitarianism…In the tradition of mesmer.
When utilitarianism is dissociated from the ethics of individual patient care, using the rhetoric of policy, the power of money and the fake facade of empathy — American Healthcare will fall.
Happy cleansing Dr. Gawande — there are many label-prone minority subsets of patients out there who pose an “unreasonable” cost to the system and there are many whose iatrogenic losses are tolerable, because the majority benefit — QoL, EoLC, LoS….let’s label them up…time to cleanse — for the benefit of our society as a whole!
Very sincerely,
Hooman Noorchashm MD, PhD.
