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September 9, 1988

Paternalism, Family Duties, and My Aunt Maude

Author Affiliations

American Academy of Ophthalmology San Francisco

American Academy of Ophthalmology San Francisco

JAMA. 1988;260(10):1406. doi:10.1001/jama.1988.03410100096024

To the Editor.—  I applaud the values-based approach of Dr Miles1 in his commentary entitled "Paternalism, Family Duties, and My Aunt Maude." In it, Dr Miles questions the appropriateness of uniform acceptance of autonomy as the overriding value in considering such surgical procedures as cataract extraction. This is a course that may benefit certain patients, yet places significant moral and medical burdens on families and practitioners alike. Given the vulnerability of individuals with limited function, including those in extendedcare and nursing facilities, these burdens are amplified.2Dr Miles' characterization of cataract surgery as "trivial" is open for considerable debate. Such a characterization is probably inconsistent with the expectations and elemental concerns of most who undergo the procedure. I believe it certainly is inconsistent with the care, precision, education, commitment, and values of most ophthalmologists. Additionally, Dr Miles refers to "cataract repair"; this is an unusual descriptive phrase, of