The call was from my mother’s case worker at the hospital.
The night before, my mother, 89, had fallen in her apartment, the seventh fall in ten days and, like the others, a direct result of her stubborn refusal to use a cane or a walker despite her unsteadiness. This time she had not been able to dissuade me from taking her to the emergency room, where we both lingered until nearly 6 AM as she was X-rayed, CAT-scanned, and given a battery of tests. The staff felt she needed to be checked-in to stay for a couple of days, especially since she was hallucinating. I agreed, over Mom’s protests; it would also provide me some more time to figure out how to prepare my home for her to move in, at least temporarily. There is no way I am going to let her fall again.
Now the case worker was calling to tell me that my mother was resisting treatment. She wanted to go home, she said, and was physically resisting efforts to give her an M.R.I. Would I please come over and persuade her?
The hospital was only fifteen minutes away, and as I drove there, I pondered various strategies. With my mother, you get one shot. If your first argument doesn’t persuade her, nothing will. I could explain why the M.R.I. would help the doctors clear her for release, but that one could backfire if the test revealed something that in fact led to a longer stay. One ploy kept pushing itself to the front of the line: tell Mom that her doctor, who had also been the primary physician for my late father and whom my mother trusted implicitly (too much, in fact, but that’s another story) has approved the procedure. If I said, “I’ve talked to Dr. Gutteridge, and he says you need to have an MRI,” that would do the trick, no doubt about it.”
There was no way to reach Dr. Gutteridge, of course. My statement would be an outright lie, and more: a violation of my mother’s autonomy and right to make an informed decision about her health care, and a misrepresentation of the doctor’s opinion, judgment and authority. It might, though I don’t think so, even undermine the long-standing relationship of trust between my mother and her physician. On the other side of the scale, I knew that my mother was phobic about hospitals. She was always paranoid in her few hospital stays; she had already complained that the staff was conspiring to keep her there, and “trying to turn us”—meaning the family—“against each other.” She had fallen so many times, and we really needed to see if there were any injuries that the other tests hadn’t uncovered.
For TV’s Dr. House, this dilemma would be easy. The hero of the long-running Fox drama “House” consistently favors lying to patients—to everyone, actually—if he believes the ultimate result will justify the deception. Little details like informed consent, respect…these things don’t matter to House. He knows what is in the patients’ best interest, and they, he is convinced, are morons. In the matter of my mother, I resolved to follow House’s lead. Taking the test was in her best interest, whether she thought so or not. I would lie to her. I would say that I had spoken to her doctor, and he wanted her to take the MRI. I had a handy rationalization, too: it is 99.999% certain that had I been able to call Dr. Gutteridge, this is indeed what he would have said. Like all rationalizations, it didn’t change anything, it just made it easier to lie to myself about whether what I was doing could be called “ethical.” I was going to lie to my mother to get her to do something she didn’t want to do, and to use deception to manipulate her conduct when she was most vulnerable.
As it turned out, I didn’t have to lie, for by the time I arrived at the hospital the staff had sedated Mom sufficiently to get her to take the test after all. Nevertheless, my decision continues to disturb me. In such a dilemma, are House’s ethics, or lack of them, justifiable? It is one thing to make ethical judgments on the conduct of Congressmen, reporters and professional athletes from a distance, with the advantages of detachment, relative obscurity, and a lack of real consequences from being wrong (other than merciless dissection by readers and the occasional blogger). Having to uphold ethical principles while dealing with one’s own family, however, poses a different challenge.
Should I have been willing to lie to Mom?
Ethics Alarms 
Jack: If you’re dealing with a person that’s in his or her right mind, of course the ethical thing is to speak honestly with the person and then let that person make the decision as whether or not to consent to treatment.
But your mom is hallucinating. She is unable to see her need for a cane or walker, despite her having fallen seven times in 10 days. She is in a state of diminished capacity; her judgment is impaired. She cannot see how her life is in danger, because she will continue to keep falling. In this situation, it is ethical to say what needs to be said, in order to preserve her life. You know that the doctor would be saying she needs these tests, if he could be reached. You needvto tell her that her doctor wants her to do what needs to be done. Her judgment is impaired. You have to do the best you can to try to save her. If her judgment is compromised, due to the ravages of age, you have to protect her. And sometimes make decisions regarding treatment for her that any rational person, in full possession of his or her faculties would make,
Hi Jack
All the argument in favor of making her to go through an MRI is in your mind. Who is hallucinating she or you? You are not a medical doctor but you have rightly concluded that Dr. Gutteridge is the right person to advice her. Maybe next time you go with her to visit Dr. Gutteridge and get a blanket permission from him in her presence that every time such an emergency arises you would get his opinion first and pass on to her that she would obey faithfully as having been given by Dr. Gutteridge.
Actually, I always go with her when she visits her doctor. But he’s not the one caring for her at the hospital; another doctor is. I can’t get Dr. G’s opinion when he’s not available, and we can’t go running to him every time she needs treatment at the hospital.
And I don’t think any Dr. should have that kind of control over a patient. Ironically, when my mother has doubts about Dr. Gutteridge’s recommendations, she asks ME. And I say, “I’m not a doctor. Listen to him, but ask questions.”
By the way, is the hospital drugging her to submit to an M.R.I. preferable to having her son persuade her with a lie?
I agree. That’s what I was wondering why the hospital is trying to drug her to get the MRI. Maybe you can have a plain talk to her about the situation when she is in good spirits, possibly now in the xmas mood, then you can have your persuasion accepted. The concern is that she keeps falling while you are not present and this creates a need for checking but doctors could confirm whether it is needed or not. It is not hallucination but doubts in the mind of your mother about the medical profession over drugging the patients. MRI scanning has its side effects for the patient. She may be right rather our feelings towards the medical profession cannot do any wrong.
Medical profession has to go back to their basics on Ethics. Even if Michael Jackson’s doctor is penalized, it does not affect others in the profession who continue to attend the patients without any consequence attributed to them. When Enron scandal broke out and Arthur Andersen had to shut down it affected the world over, wherever they had presence. Similar ethical standards need to be put through in the Medical Profession, that such indifference is brought to the notice in every country and corrective measures are taken. Now only individual doctor is quarantined and punishment is meted out. There must be an international central board for the medical profession to issue standards that the affiliated bodies take cognizance of.
I have no ethical guidance here but I hope your mother gets well soon.
Thanks. I’m grateful for the sentiment. She is, and has always been, remarkable…and my biggest fan.
Hmm . . . my disinterested status is so much in question here that I’m not sure a full disclosure is possible. It might barely be enough to say that I have partly irrational opinions about all parties involved, including myself, for reasons having little to do with ethics.
I know you. I know your mother. Peas in a pod in many ways.
So I’d ask: If your roles were reversed, would your mother lie to you?
You bet she would, without even working up a sweat.
So I think you’re in the clear. Now let’s get back to more important things, like Frosty the Snowman, the spelling of Alaskan candidates’ names, and cod flavored candy.
But Tom, as you well know, my mother’s ethics make House look like Mother Theresa. She’s always appreciated the usefulness of a good lie. Actually, that’s a good topic for a post—the seductive rationalization of the Dark Golden Rule: treating people as you know they’d treat you..and have.
Shortly before my father died, my former brother-in-law, who was a state trooper, was shot and killed in the line of duty. My brother, the doctor, my Dad’s girlfriend and, eventually, I agreed that it would be best not to tell my father, as it could impact his health. I continue to feel guilty about it; I never lied to my father — and he knew it. It felt like a betrayal, even if everyone agreed it was in his best interests. I’m glad you didn’t have to make the decision, although I don’t think sedating her was proper either. Dealing with aging and ill parents is one of the hardest things we have to do as adults, and I wish you the strength to do what you think is right as you go through it.
Yes, the hospital was right to sedate her to get the MRI. Yes, you would have been right to lie to her to get the MRI done, but they also might have had to sedate her to get her to be STILL enough for the single MRI to be of any use.
The Dark Golden Rule notwithstanding, you are still in the clear. And knowing you, if you *had* actually had to lie to her, you would have found a way to confess and work it out, because that’s what you do.