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April 8, 1998

Palliative Options at the End of Life

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(14):1065-1067. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-14-jac80003

To the Editor.—The article by Dr Quill and colleagues1misleads the reader in several critical ways. First, the authors appear to be evaluating the ethical characteristics of TS itself, when in fact their evaluation is directed entirely toward TS when combined with the withdrawing of nutrition and fluids. The authors thereby effectively combine TS and VSED and compare this combined treatment with PAS and VAE. Such misdirection is, on initial reading, rhetorically effective: One is left with the impression that, ethically, TS is tantamount to VAE or PS, when in fact nowhere in their article is there an argument for this particular claim. Similar misdirection is evident in another article comparing TS with PAS.2