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January 1, 1992

Limiting Specific Interventions in Advance Directives-Reply

Author Affiliations

Harvard Medical School Boston, Mass

Harvard Medical School Boston, Mass

JAMA. 1992;267(1):52. doi:10.1001/jama.1992.03480010059009

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In Reply.  —I appreciate Dr Lariviere's thoughtful comments, and I agree with many of them. His opening sentence, however, is misleading. My article discussed the limitations of listing specific interventions in advance directives, not "the limitations of health values forms." I am also puzzled by an apparent contradiction. He objects (as I do) to the way in which lists of requested interventions in advance directives might be construed as implying a right to medically inappropriate therapies. Yet, earlier in the letter he suggests a strategy in which a list of interventions should be honored "when the patient's condition seems hopeless."Mr Barnett and I clearly share a commitment to the goal of respecting patients' wishes. But I continue to believe that a thorough exploration of a patient's general preferences for treatment in the event of incapacity will be sufficient in most cases. During the actual period of decision making after