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June 28, 2000

Handling Conflict in End-of-Life Care

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;283(24):3199-3200. doi:10.1001/jama.283.24.3198

To the Editor: Dr Goold and colleagues1 have presented an appealing approach to family-physician conflict, which is likely to be an improvement on the unschooled but well-intentioned efforts that are generally used.

However, the case they present is so shocking in its inattentive pattern of routinized inadequate care that it should not pass without comment. The patient had Alzheimer dementia and was hospitalized with recurrent aspiration pneumonia. His son and daughter-in-law provided daily care and wanted him to live out his days at home. A consulting gastroenterologist and a resident who treated the patient on "several prior hospitalizations" for pneumonia agreed against inserting a feeding tube. However, the family wanted "everything done," including a feeding tube and resuscitation if necessary.