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In Reply. —
Unfortunately, we were not aware of the study by Dr Zinberg in the Vermont Law Review prior to his letter. His fundamental objection is to our method, which he thinks is inferior to his own. In our opinion, neither method of study, interviews or mailed surveys, is inherently superior. More important is the design of the study, especially ensuring representative subject selection and avoiding bias.Our study of a large segment of the population of physicians in Arkansas documented their self-reported experiences with and attitudes toward advance directives. Although a higher response rate than the 62.5% obtained obviously would have given us greater assurance of the validity of the results, we doubt that it would have altered the conclusions significantly. A detailed analysis of the results was not possible given the space limitations for publishing in JAMA. In any case, response to a general attitude question toward
Davidson KW, Hackler C, Caradine DR, McCord RS. Advance Directives: Do They Provide Direction?-Reply. JAMA. 1990;263(13):1764-1765. doi:10.1001/jama.1990.03440130044015