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Comment & Response
June 2019

“Not Shared” Need Not Mean “Not Patient Centered”: Deciding That a Patient Is Not a Candidate—Reply

Author Affiliations
  • 1Health Service Research and Development Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
  • 2Department of Medicine, University of Washington, Seattle
JAMA Intern Med. 2019;179(6):852. doi:10.1001/jamainternmed.2019.1237

In Reply As Blythe and colleagues outline, the “best interest” approach to decision making gives clinicians discretion to unilaterally carry out or withhold treatments without soliciting input from or collaborating with patients when they believe that this is in patients’ best interest. This approach assumes that clinicians know what interventions will be most beneficial and least harmful for individual patients. The difficulty with this approach, however, is that it is impossible to know how patients might weigh the benefits and harms of treatment without knowing their values and goals. Furthermore, clinicians often do not agree with their patients on what is most important near the end of life1 and cannot always accurately predict prognosis or the effects of treatment in individual patients.2

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