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May 23/30, 2001

Planning Medical Services for the End of Life—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor


Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2001

JAMA. 2001;285(20):2578-2579. doi:10.1001/jama.285.20.2578

In Reply: I do not advocate "eliminating an existing [hospice] reimbursement," as Dr Alexander contends. Reforms will require testing of other innovative approaches. Hospice is the only widely available, comprehensive, generally well-liked care program for the end of life. I hope we can build on its successes.

Alexander also objects to my claim that interdisciplinary teams might limit physician autonomy. Working with effective, knowledgeable teams probably enhances the insight and creativity of care planning, but it also limits the authority of the physician to act alone. Since this restricts opportunities to act on inadequate information or idiosyncratic preferences and habits, this would probably improve quality. Thus, physicians should embrace this restriction.

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