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—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
Brett AS. Limiting Specific Interventions in Advance Directives-Reply. JAMA. 1992;267(1):52. doi:10.1001/jama.1992.03480010059009