Sir.—We read with interest the article by Botkin1 in the August 1989 issue of AJDC on informed consent for lumbar puncture. In discussing the scenario involving parental refusal of lumbar puncture despite clear medical indications, Botkin recommends that lumbar puncture and treatment proceed without consent unless a court order can be obtained promptly. In practicality, it is difficult to have the parents relinquish their child for a procedure that they strongly oppose, and it is equally difficult and very time-consuming to physically restrain parents in that situation.
Another approach that we have used on occasion when a parent refuses an essential diagnostic study, such as a lumbar puncture, is to begin empiric treatment and admit the child to the hospital. Often the parents may be adamant in refusing the diagnostic test (for a wide variety of reasons) but are willing to allow blood work and intravenous antibiotics. In
AVNER JR, SELBST SM. Informed Consent for Lumbar Puncture: An Alternative. Am J Dis Child. 1990;144(3):272. doi:10.1001/archpedi.1990.02150270018014