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About Intending Death: The Family and Quality of Care-Reply
John M. Freeman, MD
The Johns Hopkins Medical Institutions Baltimore, Md
Edmund D. Pellegrino, MD
Georgetown University Medical Center Washington, DC
Arch Fam Med. 1994;3(3):217.
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In reply
We thank Fetters for his compliments. We clearly believe in the importance of the values of the family and of society in making critical decisions at the end of life, but we believe in the primacy of an individualized, patient-centered approach. Throughout the article, we emphasized certain principles that should guide all providers. These principles are independent of the nature of the illness and the ethical approach of the providers.
Decisions at the end of life should always involve the family and should be in concert with the wishes of society as expressed by its laws. However, decisions must always be patient centered, even when surrogates are "legally" appointed.
Fetters is correct in stating that two patients with the same severity of illness could receive markedly different quality and quantity of care from two equally conscientious physicians. Indeed, two patients with the same illness could receive different care even from
. . . [Full Text PDF of this Article]
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