In Reply I believe that a lot of the objections by Drs Taylor and Wu to how I handled the situation are a result of misunderstandings likely born of my attempts to create a terse and impactful narrative describing my immediate thoughts and reactions. In writing this narrative, I did not include the many other individuals with whom I spoke and consulted in caring for the patient. The letter is helpful in offering guidance about incorporating palliative care and ethics specialists when needed. By saying that the patient “has chosen comfort measures over life-sustaining ones” and “we have nothing left to offer him but our best efforts to ease his pain,” I was trying to let the reader know that palliative care was involved in the patient’s care, that he had chosen to be DNR, and that he had been an active participant in all of these decisions.
Trappey BE. Moral Dilemmas for Physicians Treating Terminal Patients—Reply. JAMA. 2018;320(1):95–96. doi:10.1001/jama.2018.6590
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