To the Editor: In his Grand Rounds, Dr Carrese1 provides a cogent and practical approach to the problem he terms “refusal of care.” However, the accompanying case discussion demonstrates several pitfalls that appear when principles encounter the reality of clinical decision making. The crux of the described case was that the patient's “well-being and her wishes appeared to be in direct conflict.” Unfortunately the end result was that neither her well-being nor her wishes were achieved. We see 2 concerns with the case as it developed.
Spiess JL, Tomm L. Refusal of Care by Patients. JAMA. 2006;296(24):2921–2923. doi:10.1001/jama.296.24.2922-a
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