PERSPECTIVE WHAT WOULD YOU DO IF IT WERE YOUR KID> second-line therapy a try. Things us, to make our involvement per- and not ever having stood where did not go well. Within 2 months, sonal. They re entreating us to my patient's family stands, I'm Lizzy had a worn and vacant approach them or their relative not certain how I'd react. Then I stare, and her normally animated not just as another case, but as a say, " But here is what I think I ace was expressionless human being with as much value would do Q. Then, during an MRI, she in- as our own sons and daughters, edge the extraordinarily stressful plicably went into respiratory mothers and fathers. It's another decision they're wrestling wit istress and was whisked away way of asking for guidance, a plea while providing some guidance to the emergency department. I to share with them, as a partner, by answering their question. Fam- saw her in the trauma bay, labor- the heavy burden of decision ilies deserve an answer however ing to breathe, her eyes ablaze making difficult it may be for us to pro- with fear and confusion. She They may not appreciate, how- vide it. would die if she wasn't intubat- ever. that when it comes to mak- But what if what we're recom ed. But should she be? We went ing medical decisions for our own mending for our patient is differ- back and forth: she would ulti- families, we may draw on our ent from what we would do for mately die of her disease, and emotions at least as much as the our own child or spouse? Do we perhaps that was happening now. objectivity required for sound share that information? Or is it But it was so sudden, and what if medical decisions. In addition, acceptable to be less than truth the problem was something fix- medical decisions, particularly re- ful? I recall meeting with the able - a pulmonary embolus or garding goals or limits of care, parents of a 9-month-old with aspiration pneumonia? On the are seldom straightforward and progressive neurodegenerative dis- other hand, how much more depend on the medical scenario, order who was beginning to should a dying child have to en- the patient, the family, and their cough and choke when fed. The dure? Yet those of us who loved culture and philosophy of care. discussion centered on whether a Lizzy were ill prepared to let What I might want for my daugh- G-tube should be placed in this ter(and what she might want) infant whose prognosis would be To escape the chaos of the may be very different from what very poor either way. The par- mergency department, I sat with Lizzy and her family want. rventionist Lizzy's parents squeezed into a So how do we answer? How were inclined to let things take storage room crowded with moni- do we balance our professional their natural course. But the tors and IV poles. We discussed judgment with the very personal feeding issue was hard for them. the pros and cons of intubation, judgments that such a question My sense was that they didn't and through tears her mother asks us to make? We could avoid want to have the G-tube inserted asked me, "What would you do if answering altogether, explaining and were looking for permission that since we're not in the same not to do it then the father suppose we've all been asked situation we cannot possibly know asked, "What would you do if that question: What would you do what we would do. But though were your kid, doc? if it were your child, your mother, there may be truth in that answer, My mind raced: "What would your brother, your husband? Some- it denies our patients an impor- I do, what would I do times I've asked people what they tant piece of information that this were my child, I thought, I mean by this question and may help them make an agoniz- would want the G-tube. But isn't been answered by puzzled looks ing decision. Another option is to that the father in me, making a saying, "What do you mean what answer as honestly as possible. decision based on my own family, do I mean? i just want to know I often combine these ap- culture, philosophy, values, and kid!"People may ask this ques- be presumptuous to think I could the physician's recommenatGn oa what you would do if it were your proaches, explaining that I would emotions? Is this man seeking tion because they reasonably as- say with confidence what I would or the father's -or is he even sume that the option we 'd choose do if it were my child, because considering that distinction? If I for those we love the most is the when it comes to my child, my tell him what I would do if it best option and therefore the thinking is more emotional than were my kid, might I inadvertent- most appropriate for them. They rational. In that situation, I'm a ly put some pressure on this fam- ay also be seeking to humanize father more than a physician, ily to do what their instinct tells 1292 N ENGL J MED 369: 14 NEJM.ORG OCTOBER 3, 2013PERSPECTIVE 1292 n engl j med 369;14 nejm.org october 3, 2013 second-line therapy a try. Things did not go well. Within 2 months, Lizzy had a worn and vacant stare, and her normally animated face was expressionless. Then, during an MRI, she in￾explicably went into respiratory distress and was whisked away to the emergency department. I saw her in the trauma bay, labor￾ing to breathe, her eyes ablaze with fear and confusion. She would die if she wasn’t intubat￾ed. But should she be? We went back and forth: she would ulti￾mately die of her disease, and perhaps that was happening now. But it was so sudden, and what if the problem was something fix￾able — a pulmonary embolus or aspiration pneumonia? On the other hand, how much more should a dying child have to en￾dure? Yet those of us who loved Lizzy were ill prepared to let her go. To escape the chaos of the emergency department, I sat with Lizzy’s parents squeezed into a storage room crowded with moni￾tors and IV poles. We discussed the pros and cons of intubation, and through tears her mother asked me, “What would you do if it were your kid?” I suppose we’ve all been asked that question: What would you do if it were your child, your mother, your brother, your husband? Some￾times I’ve asked people what they mean by this question — and been answered by puzzled looks saying, “What do you mean what do I mean? I just want to know what you would do if it were your kid!” People may ask this ques￾tion because they reasonably as￾sume that the option we’d choose for those we love the most is the best option and therefore the most appropriate for them. They may also be seeking to humanize us, to make our involvement per￾sonal. They’re entreating us to approach them or their relative not just as another case, but as a human being with as much value as our own sons and daughters, mothers and fathers. It’s another way of asking for guidance, a plea to share with them, as a partner, the heavy burden of decision making. They may not appreciate, how￾ever, that when it comes to mak￾ing medical decisions for our own families, we may draw on our emotions at least as much as the objectivity required for sound medical decisions. In addition, medical decisions, particularly re￾garding goals or limits of care, are seldom straightforward and depend on the medical scenario, the patient, the family, and their culture and philosophy of care. What I might want for my daugh￾ter (and what she might want) may be very different from what Lizzy and her family want. So how do we answer? How do we balance our professional judgment with the very personal judgments that such a question asks us to make? We could avoid answering altogether, explaining that since we’re not in the same situation we cannot possibly know what we would do. But though there may be truth in that answer, it denies our patients an impor￾tant piece of information that may help them make an agoniz￾ing decision. Another option is to answer as honestly as possible. I often combine these ap￾proaches, explaining that I would be presumptuous to think I could say with confidence what I would do if it were my child, because when it comes to my child, my thinking is more emotional than rational. In that situation, I’m a father more than a physician, and not ever having stood where my patient’s family stands, I’m not certain how I’d react. Then I say, “But here is what I think I would do . . . .” I thus acknowl￾edge the extraordinarily stressful decision they’re wrestling with, while providing some guidance by answering their question. Fam￾ilies deserve an answer, however difficult it may be for us to pro￾vide it. But what if what we’re recom￾mending for our patient is differ￾ent from what we would do for our own child or spouse? Do we share that information? Or is it acceptable to be less than truth￾ful? I recall meeting with the parents of a 9-month-old with a progressive neurodegenerative dis￾order who was beginning to cough and choke when fed. The discussion centered on whether a G-tube should be placed in this infant whose prognosis would be very poor either way. The par￾ents, of a noninterventionist bent, were inclined to let things take their natural course. But the feeding issue was hard for them. My sense was that they didn’t want to have the G-tube inserted and were looking for permission not to do it. Then the father asked, “What would you do if it were your kid, doc?” My mind raced: “What would I do, what would I do . . . ?” If this were my child, I thought, I would want the G-tube. But isn’t that the father in me, making a decision based on my own family, culture, philosophy, values, and emotions? Is this man seeking the physician’s recommendation or the father’s — or is he even considering that distinction? If I tell him what I would do if it were my kid, might I inadvertent￾ly put some pressure on this fam￾ily to do what their instinct tells What Would You Do if It Were Your Kid?