RSS Feeds
Communicating End-of-Life Decisions
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
Hofmann and colleagues [1] have made a valuable contribution to the understanding of the complex determinants of poor physician–patient communication. Many have assumed that the low rates of advance directive orders in hospitalized patients are attributable to physician paternalism, lack of training, or inadequate resolve to discuss difficult end-of-life issues. I was struck by the authors' finding that most patients did not desire discussion of preferences for cardiopulmonary resuscitation (58%) or prolonged mechanical ventilation (80%). These were sick patients at risk for poor outcomes, most of whom were already participating in critical health care decisions. Yet, they seemed to express a “don't ask, don't tell” attitude about end-of-life issues that many physicians had hoped was a relic of the world before the patient autonomy movement.
This poses a serious ethical challenge. If informed patients indicate that they do not desire any further discussion of advance directives, do physicians (or patient-rights advocates) have an ethical obligation or right to “educate” them to the contrary? Would this be any different from deciding that a patient who refused to participate in a clinical trial really needs to be “educated” more about the trial and thus could or should be approached again?
We will all need to be creative about ways to foster more informed discussions of end-of-life preferences in ways that truly respect a patient's autonomy, including a patient's ultimate right to decide “not to tell” after being asked.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
