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January 15, 1997

The Last Refreshing Taste-Reply

Author Affiliations

Rush-Presbyterian-St Luke's Medical Center Chicago, Ill

JAMA. 1997;277(3):212. doi:10.1001/jama.1997.03540270038020

In Reply.  —I thank Dr Rousseau for his kind words and interesting remarks. I wholeheartedly agree with his comments and wish to expand on them by using a patient's perspective, addressing some of the points I did not discuss in the Lemonade articles, including the use of advance directives, the value of hospice and palliative care, and the emotional state of the severely ill or dying patient.Treatment for a serious illness such as cancer often progresses in the form of "two steps forward and one step back." As Dr Elisabeth Kubler-Ross discussed in her enormously influential book, On Death and Dying, terminally ill patients experience certain psychological changes as they progress toward death. She delineated 5 stages1: denial and isolation, anger, bargaining, depression, and acceptance. Moreover, patients often feel depression, then acceptance, and then depression again concerning "what might have been." However, this labile process is normal and does not