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January 1, 1992

Limiting Specific Interventions in Advance Directives

Author Affiliations

Hitchcock Clinic Bedford, NH

Hitchcock Clinic Bedford, NH

JAMA. 1992;267(1):51. doi:10.1001/jama.1992.03480010059007

To the Editor.  —The article by Dr Brett1 on the limitations of health values forms is well-stated and thought-provoking. I agree that it is very important that each person state specific goals, such as relief of pain or a peaceful death. Perhaps all such lists should be preceded by a statement that requests a trial of such therapies if the proxy and the physician think it may restore a function important to the patient, such as the ability to communicate or to relieve pain.The list of specific interventions would be honored only after such a trial fails or when the patient's condition seems hopeless or when there are therapies that violate a patient's known religious beliefs. I disagree that "if proxies or physicians [can] override the patient's... choices... little reason existed to complete a detailed checklist in the first place."1 If the options chosen by those making