To the Editor.
—The thoughtful discussion of the Patient Self-Determination Act of 1990 by La Puma et al1 and White and Fletcher2 is timely because of the recent December 1,1991, deadline for the act's implementation by hospitals, nursing homes, and hospices. However, there is a danger that health care professionals forced by legislatively imposed time constraints merely to comply with the act, may then, in their zeal, mistakenly become salesmen of advance directives to acutely ill hospitalized patients. Both sets of JAMA authors agree that the acute care setting is not optimal for discussion of advance directives, and then inexplicably go on to discuss additional ways to involve the attending physician and primary nurses in such discussions. It seems that the authors agree that it is not just legally expedient, but ethically correct to make the treating physician the salesman of advance directives to patients who, the authors
Grant K. Reimbursement, Beneficence, and Advance Directives. JAMA. 1991;266(24):3424. doi:10.1001/jama.1991.03470240046023