In Reply. —
We appreciate Sherman's thoughtful response to our editorial,1 and we endorse his suggestions for effecting the rational application of intensive care services. We, too, worry that the pendulum has swung so far toward emphasizing the primacy of the patient as a decision maker that patients do not receive sufficient guidance from physicians. Guidance should take the form of careful discussions of reasonable treatment options and their potential efficacy, and it should include recommendations from the physician regarding the use of life-sustaining therapies.Patients, or their families, should never be asked to choose between "doing everything or not." When questions of withholding or withdrawing life-sustaining technologies arise, discussions with patients or family members focus too much on treatments that will not be provided and too little on what treatments will be employed to reach mutually agreeable goals. No wonder family members fear that if they agree to
Bone RC, Elpern E. Doing Our Part to Match Patient Preferences With Rationed Intensive Care-Reply. Arch Intern Med. 1992;152(6):1332–1333. doi:10.1001/archinte.1992.00400180168038
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