As a practicing physician and longtime member of his hospital’s ethics committee, Dr. Barron Lerner thought he had heard it all. But in the mid-1990s, his father, an infectious diseases physician, told him a stunning story: he had physically placed his body over an end-stage patient who had stopped breathing, preventing his colleagues from performing cardiopulmonary resuscitation, even though CPR was the ethically and legally accepted thing to do. Over the next few years, the senior Dr. Lerner tried to speed the deaths of his seriously ill mother and mother-in-law to spare them further suffering.
These stories angered and alarmed the younger Dr. Lerner—an internist, historian of medicine and bioethicist—who had rejected physician-based paternalism in favor of informed consent and patient autonomy. The Good Doctor is a fascinating and moving account of how Dr. Lerner came to terms with two very different images of his father: a revered clinician, teacher and researcher who always put his patients first, but also a physician willing to “play God,” opposing the very revolution in patients’ rights that his son was studying and teaching to his own medical students.
But the elder Dr. Lerner’s journals, which he had kept for decades, showed his son how his outdated paternalism had grown out of a fierce devotion to patient-centered medicine that was rapidly disappearing in a world of managed care, spiraling costs and health care reform. And they raised questions: Are paternalistic doctors just relics or should their expertise be used to overrule patients and families that make ill-advised choices? Does the growing use of personalized medicine—in which specific interventions may be best for specific patients—change the calculus between autonomy and paternalism? And how can we best use technologies that were invented to save lives but now too often prolong death? In an era of high-technology medicine, spiraling costs and healthcare reform, these questions could not be more relevant.
As his father slowly died of Parkinson’s disease, Dr. Lerner faced these questions both personally and professionally. He found himself being pulled into his dad’s medical care, even though he had criticized his father for making medical decisions for his relatives. Did playing God—at least in some situations—actually make sense? Did doctors sometimes “know best?”
A timely and compelling story of one family’s engagement with medicine over the last half century, The Good Doctor is an important book for those who treat illness—and those who struggle to overcome it.