There have been times when a family has asked me to be dishonest, like when they ask me to write a work excuse for the father and ask me to make it for longer or a different time than it should be. I decline those requests. I figure if I lie for them then they won't trust me when I'm giving them information about their baby.
Sometimes, though, I wonder if I have to tell them all the truth. I think specifically of obtaining "informed" consent. The most common procedure for me to obtain consent for is a spinal tap, also known as a lumber puncture. The purpose of this is to find out if the baby has meningitis. If you miss meningitis in a baby, it can ruin the baby's whole life. In general it is a very safe and useful procedure, and we don't do it unless its benefits outweigh the risks. In one instance I am aware of, though, in a case of a pediatrician acquaintance of mine, a baby was paralyzed by the spinal tap. It was a two month old baby who had hemophilia, although the hemophilia had not yet been diagnosed. The baby had increased bleeding from the spinal tap because of the hemophilia, and the blood compressed and damaged the spinal cord, leaving the baby a paraplegic.
That is a tragic case. It is also extremely rare. My question is, do I have to tell parents about this when I tell them the risks of a spinal tap? Do I have to mention paralysis as a risk? If I were being totally honest, I guess I would, but there is a very real concern that some parents, already skittish about a spinal tap, might decline it if I tell them that, and that would not be good, because it is extremely important we don't miss menigitis. Like I said, I wouldn't do the spinal tap unless the benefits outweighed the risks. A further question might be, should we even have to obtain informed consent for spinal taps? Why do we? I know that patients' rights advocates won't like this, but think about it. As a doctor, I am trained to evaluate the risks versus benefits; the parents are not. Why do they get to choose an option that might not be in the baby's best interests?
I'll stop here. I've probably already said enough that I'll receive some flak. In the meantime, though, I'll try to be honest with parents. I hope I'm honest enough.