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To the Editor: In the study of the association between religious coping and receipt of mechanical ventilation by Dr Phelps and colleagues,¹ I take issue with how the end-of-life goals of care were framed. "Preferences for heroics" and "do everything possible," as used in this study, are terms that are strongly discouraged in the communication training laboratory in which I work. These are value-loaded medical metaphors that are prone to misperception. A physician may understand that they refer to futile end-of-life treatment or cardiopulmonary resuscitation, but a patient may not have this shared perspective.

Patients may interpret the opposite of "heroic" as cowardly, and the opposite of "doing everything" as "doing nothing." Would patients prefer a physician who uses heroic measures or cowardly measures? Would patients prefer a physician who is willing to do everything for them or a physician who only goes halfway on their behalf?

I am concerned . . . [Full Text of this Article]

Tomer Trevor Levin, MBBS
levint@mskcc.org
Comskil Laboratory
Memorial Sloan-Kettering Cancer Center
New York, New York

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