Wednesday, August 19, 2015

If it were my parent...

[In case you are interested, I prepared a brief podcast for "The Famous Abba" for Parshas Shoftim; it's available here. The site also offers a "Shabbos Sheet" available here.]

The scene takes place all the time, in hospitals everywhere. An elderly patient is unconscious, and in danger of imminent death. Only dramatic medical intervention will save the patient's life. The family agonizes over the decision - What would Mom want?

The family consults medical staff, who explain the situation and outline the various options. And then a sympathetic doctor or nurse adds, "If it was my mother, I would..." "This happened with my father, and..."

The medical professionals mean well, of course; they are demonstrating that their advice is grounded in a sincere desire to help. What could be more sincere than their actions for their own parents?

Nonetheless, I fear that this approach is morally wrong.

It is true that medical professionals are more familiar with the treatments and their likely outcomes. And it is certainly true that they have a better medical understanding of what is happening. However: Whatever the doctor or nurse would do for their parents would not be a pure medical decision - it would involve many external factors, from their personal ethical codes to their relationships with their parents to their relationships with the other decision-makers, and so on. In short, this is not medical advice, but in our situation it is being offered with misplaced medical authority.

In the context of a hospital room, at a moment when medical professionals are speaking with authority on the medical situation, that authority is easily transferred to their non-medical advice. It is difficult for distraught families to discern where medical advice ends and non-medical advice begins. To my mind, trading on the respect patients have for their medical knowledge to promote a particular path is inappropriate.

To give an example from another field: If a stock broker were to advise me on my investments by saying, "I would suggest investing in XYZ mutual fund; that's where I've told my mother to invest," that would be inappropriate. Without explaining her mother's portfolio, stage in life, and personality, she would be presenting me with an incomplete picture - while giving it the weight of her authority in investing.

Twice, I've mentioned this problem when speaking to medical groups; each time, my perspective has been met by a mix of nodding heads and immobile heads. My sense is that the non-responsive participants think I'm wrong, but I'm not clear on why. Where is the flaw in my objection?


  1. If a doctor suggests "If this was my father, I'd..." then cut him off and say "You'd ask a professional for advice because in that situation you're not a doctor, you're a son."
    Patients also often ask me "If this was your mother..." and I respond "then I'd ask her doctor because I'm her son, not her doctor."

  2. What any or all of the interested parties (e.g., the patient, the doctor, the patients' relatives) might want, even if it was perfectly understood, could still be in conflict with Halacha.

  3. The NYTimes had a piece a few years ago by a doctor who observed that so many procedures and treatments today are painful but important. So don't ask "would you prescribe this to a parent?", as they might not. Instead, "would you prescribe this to stranger?"

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  6. Paralysis of analysis comes to mind. It is hard to figure out how much weight to apply to some situations because there are always a million variables that come into play.

    Some people like hearing what the doctor would do in their shoes because they feel they are getting a more honest answer.

    As to whether or not they should advise, well I see both sides and with that I am clearly straddling the fence. :)

    Shana Tova.

    1. All true, Jack, including the straddling. And good to hear from you; shanah tovah back at you!