Dr. Lerner, Author Of 'The Good Doctor,' On Evolution Of Medical Ethics
A prominent physician, ethicist and author, Dr. Barron Lerner weighs in on his book The Good Doctor, which highlights the evolution of medical ethics, with details from his father's medical career to illustrate. Dr. Lerner is also a professor of medicine at the New York University Langone Medical Center.
On the original method of training doctors
"In those days, you almost learned how to be a doctor from other doctors. You went to lectures and then you followed doctors around in the wards as a clinical clerk. No one really taught you what it was like to be a doctor, no one taught you medical ethics so that was a big part of it. It was sort of osmosis. The other thing that was so unrecognizable was how much time people spent in the hospital. My dad and his peers practically lived in the hospital during their training years, that’s why the term house officers existed. So that’s another aspect of medicine that has changed pretty dramatically."
On his father’s cases and decisions that would seem improper today
"One was a patient who he saw who had late-stage AIDS in the late 1980s and my dad decided by himself that he wasn’t going to offer the patient the possibility of chemotherapy for his probable lymphoma but was just going to give him pain medications to make him comfortable. He did that based on what he called a “tacit understanding” he had with the patient. A second case which was even more dramatic was one in which my father physically placed his body on top of a woman who had just died because he thought she should not be resuscitated. She had been in the hospital for months and incapacitated for years and did not have a do not resuscitate order. He felt so strongly that her life was such agony that he physically got on top on her and prevented his colleagues from doing CPR. Those are two pretty outrageous incidents from our modern perspective."
On how he’s come to terms with his father’s experiments as an ethicist
"Well, I was going through my dad’s journals and there it was, I found that he had done experimentation at a home for mentally disabled boys outside of Boston. It really leapt out at me, as someone who had studied extensively the history of bioethics, these were exactly the sort of problems and scandals that had led bioethics to take form. Here was my dad having participated in the same exact things. At first I was pretty horrified, and I put on my historian’s hat and talked to him about it a little bit. The fact was, it was incredibly common in those days. Doctors felt that for the good of science, they could do experiments that would benefit humanity but may or may not benefit the subjects involved. It’s pretty jarring but I tried to understand it in the context of the time which was much more permissive. Wearing my ethics position, I realized as I was working on the book that I was a historical figure too. It would be understandable if people looked back 50 years at us and our generation of bioethicists and asked what we were doing. I concluded at some point that maybe in our world our allegiance to patient rights and autonomy and our rejection of paternalism had gone so far that perhaps one day, future historians would look back at what we were doing now and asking why we had been so vehement in our support of giving patients the right, in some cases as doctors, to do things we knew didn’t make sense."
On lowering the pressure and burden of making medical decisions as a patient
"I think the goal overall is still to empower patients and family members to learn as much as they can and as much as they want about these things and to try to incorporate what we know about patients and their lives into these medical decisions. Having said that, there’s truth to the fact that we so often are asking these complicated questions to people and expecting them to come up with brilliant answers and the right answer at times of crisis…At some point it gets kind of crazy. I’m hoping that there’s some way doctors can begin working with the ethics community and patients rights advocates to begin to try to make these questions better and take some control of the situation by offering people options that make sense, not just every option."