We agree with Burke and Travaline regarding their concerns about the properties of the DS-DAT. For this reason, our article included an extensive consideration of the methodological issues, including all possible problems with the DS-DAT, among which is the possibility that the level of consciousness might affect the score on the DS-DAT.1 Because of these considerations, we explicitly mentioned that conclusions should be drawn carefully.
Pasman HRW, Onwuteaka-Philipsen BD. Recognizing Patient Discomfort When Forgoing Artificial Nutrition and Hydration in Severe Dementia—Reply. Arch Intern Med. 2006;166(4):472. doi:10.1001/archinte.166.4.472-b