Stephen J.LurieMD, PhD, Senior EditorJody W.ZylkeMD, Contributing Editor
In Reply: Although I appreciated Dr Swenson's teaching and clinical insights, his criticisms of the story bear little relation to the larger issues of cultural sensitivity and end-of-life care that the story addressed.
Swenson complains that the story is written as a first-person account; no such event took place during our week in the Arctic. However, this does not mean that such events do not occur in the village I was writing about. Several residents and patients in Nome related similar stories throughout my 5-week stay. As I wrote the story, I was aware of the need to condense events to present a formalized and palatable essay—one that would raise the pertinent issues of medicine and cultural context in a readable format. This was necessary to protect patient confidentiality and falls well within the limits of artistic license. Swenson himself acknowledges both these needs, stating he understands the need to alter events ". . . to make it a better story." Thus, the ultimate purpose of the story was hopefully served, and the medical community can concentrate more on end-of-life issues and less on stylized writing.
Shah SI. A Story About Suicide in the Arctic—Reply. JAMA. 2001;286(8):919. doi:10.1001/jama.286.8.919-JLT0822-6-2