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I thank Dr Rosner for writing and for promoting the discussion of the difficult issues surrounding terminal care. Efforts (such as the living will) to begin to bring some order and some meaningful expression of the wishes of the patient into terminal care are clearly at an early stage and, as pointed out by Eisendrath and Jonsen and in my editorial, require considerable further development. This is why clear and free communication between physician and patient is of such critical importance. The living will should not simply be accepted and filed in the patient's chart without discussion of its implications and without efforts by the physician to gain deeper understanding of what the patient means when he speaks of "no hope" or "heroic measures." The concept of terminal illness is best not measured in terms of time but rather in terms of irretrievability. It is the absence of
Jeremiah A. Barondess. The Living Will-Reply. JAMA. 1983;250(20):2789. doi:10.1001/jama.1983.03340200023012