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April 21, 1978

Dying at Home

Author Affiliations

Mountain View, Calif

JAMA. 1978;239(16):1612. doi:10.1001/jama.1978.03280430028011

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To the Editor.—  I wish to add several points to the article "Dying at Home" (238:2405, 1977).First, the physician is indispensable as a guide in helping patient and family to cope with the program. The physician must be honest about the terminal state as well as about the prognosis at all stages of the illness to retain the confidence of the family.There are families who do not want to know the truth or do not want the patient to know the truth. The contract is between physician and patient, and the patient should always be informed of the truth. Family wishes can be listened to but only rarely honored. In addition, the physician can tactfully gain the confidence of the family members to guide them to the reality of the situation, especially by explaining that the contract is between physician and patient. Beliefs in unreal approaches are usually