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In Reply.—The option of initiating treatment for a child with suspected meningitis without performing a lumbar puncture is not a good one from the narrow perspective of the child's health. This approach may lead to unnecessary or inappropriate treatment and it may limit public health measures. Nevertheless, Drs Avner and Selbst's point is well taken. From the broader perspective of the child's welfare and the welfare of the family, this may occasionally be the best of bad options.
There is, of course, a distinction to be made between having the moral authority to override parents' wishes in situations of this type and believing that such an action is right in specific circumstances. Physically wrenching a child from the parents for a diagnostic procedure would be beyond the ability of many physicians who may in good conscience choose the compromise suggested by Drs Avner and Selbst. Should the parents refuse treatment in
BOTKIN JR. Informed Consent for Lumbar Puncture: An Alternative-Reply. Am J Dis Child. 1990;144(3):272. doi:10.1001/archpedi.1990.02150270018015