When The Doctor Knew Best

James Hamblin interviews Dr. Barron Lerner about his new book The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics:

Hamblin: The book begins with this story of an elderly patient that your father prevented from being resuscitated.

Lerner: This is one of those patients that had been in the hospital for months and wasn’t getting any better and was in pain and suffering, daily. My dad basically thwarted the rules that said you have to resuscitate someone if they don’t have a Do Not Resuscitate (DNR) order. It was the height of his paternalism. And he even acknowledged that.

My initial response was to feel pretty appalled because I was teaching bioethics at the time, and here was my own father violating one of the cardinal rules of bioethics. But part of the journey of my book was to immerse myself in his journals and understand his whole mindset about doctoring in patients, and in that context even though most people would say that what he did was illegal and unethical, I entirely understood his reasoning. It was just a completely futile resuscitation and just inappropriate, and he took it upon himself to prevent it.

Speaking with Terry Gross, Lerner notes that his father wasn’t always honest with cancer patients about their condition:

His decisions were based on what I think he would’ve called “knowing the patient incredibly well.” So he didn’t have hard and fast rules. In some cases, when he felt that patients wanted the information and wanted to be involved in decision-making, he would give the information. But in other instances, he sort of quietly decided not to or he parsed out information in various ways.

Again, this was not uncommon in that era. In fact, oncologists routinely didn’t tell patients they had cancer; they used all sorts of euphemisms. My dad rationalized this by his intense involvement with the patients and their lives and their families. He felt, indeed, that it was his duty as a doctor to obtain the information that would help him guide their decisions. He felt, for example, just telling patients what they had and what their options were was a dereliction of his duty as a doctor.