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May 11, 2011

Patient Autonomy and Clinician Integrity in Treatment Decisions—Reply

JAMA. 2011;305(18):1861-1862. doi:10.1001/jama.2011.586

In Reply: We presented a case describing complex medical decision making involving a 28-year-old man with chronic granulomatous disease. As the case began, he and his physicians were preparing for a genetically modified stem cell transplant, an innovative but potentially curative therapy. The patient had spent more than 1000 days of his life in the hospital. A cure would have been, in our opinion, an appropriate use of medical resources.

During the illness episode described, it was unclear whether the patient would recover. The clinicians recommended that the patient return to the intensive care unit, given the severity of his infections. Because of his previous experience in the intensive care unit, the patient declined. This was his decision to make. However, the patient wanted all other available interventions that would give him a chance of getting the transplant. For this reason, the team did not recommend hospice.

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