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April 15, 1992

Deciding About Death

Author Affiliations

University of Alabama School of Medicine Birmingham

JAMA. 1992;267(15):2036. doi:10.1001/jama.1992.03480150042024

To the Editor.  —In a recent JAMA Editorial,1 Kjellstrand brought into focus future problems emanating from the recently established Patient Self-determination Act. Kjellstrand suggests that physicians will need a script in order to best play out their role in the patient's end-of-life experiences.I believe that this recent emphasis on the patient's self-determination in the events surrounding death and dying draws the physician toward an inappropriately passive position. Patients are now entitled to prescribe the course of events, such as do not resuscitate orders and similar instructions, with expectations that physicians will comply unhesitatingly. I believe that many physicians, when confronted with critical end-of-life situations and these scripts carefully written by the patient, will suddenly realize major conflicts between what the patient has prescribed and what he or she as a physician is willing to fulfill. Recently, Boyd and Boudreaux2 presented evidence that a large percentage of