Parents' Roles in Medical Decision-Making
ALEX CHADWICK, host:
And we're joined now by Dr. John Lantos. He's a pediatrician and a bioethicist at the University of Chicago and he knows about this issue of doctors and parents. Dr. Lantos, let me ask you. Are you a parent as well?
Dr. JOHN LANTOS (University of Chicago): Yes, I have three daughters.
CHADWICK: So you must be, you know, especially familiar with this idea of when would a parent's rights be superceded by a doctor? Can you imagine yourself being confronted with this problem?
Dr. LANTOS: I can. And it is a difficult problem all around because doctors and parents both generally have the same goal, which is to do what's best for the child.
CHADWICK: And how do you know when you are going to do what is best for the child when you know better than a parent what would be a significant risk of serious harm, as this doctor we've just heard has said?
Dr. LANTOS: Well, everybody's intuition I think is a guide on this. There are cases where it's clearly not in the child's interest to go without treatment. If a child came in with all the signs and symptoms of appendicitis and the parent said we don't believe in surgery, it would clearly be in the child's best interest and I think the doctors would be justified in seeking a court order or taking emergency protective custody.
If it was a situation with an incurable cancer and the doctors were insisting that the child be given toxic and non-beneficial chemotherapy and the parents instead wanted palliative care or alternative medicine, I think most people would judge the parents to be correct in that situation. And the tough cases fall in between those, and what ethicists and judges try to do is figure which paradigm case they are closer to.
CHADWICK: I'm very interested to hear you respond by saying you should follow one's intuition, because we were having an editorial discussion at a DAY TO DAY meeting about this previous report by Tom Banse and realized we didn't quite know how to think about this. We don't know what is the right thing to do, and you're saying one's own intuition is a good guide. That's not what I expected to hear from you.
Dr. LANTOS: Well, the intuition has to be based on the facts of the case and each particular case will have its own set of facts. So I think the role of the medical profession here is to make sure everybody's working with the same set of facts. What do we know about the diagnosis, how sure are we of the prognosis, what do we know about the effectiveness of treatment? And those facts then provide the template, the background upon which you then have to make an intuitive judgment. Is this clearly in the child's best interest? Is it a matter of parental discretion? Or is it something in between?
CHADWICK: Do you testify or do you get into cases like this - because I wonder how it would be for you as a doctor and a parent to look into a parent's eyes and say, no, you're not going to make the choice on this, I am.
Dr. LANTOS: I've been called on some cased like that and depending on the facts of the case have taken both sides. There have been some cases where I have thought the parents were correct and the doctors were over-reaching. There have been other cases where I thought treatment was morally obligatory and the parents were neglectful.
CHADWICK: John Lantos is a pediatrician who teaches at the University of Chicago. Dr. Lantos, thank you.
Dr. LANTOS: Thank you.
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