To the Editor.
—Dr Brett's arguments against specifying unwanted interventions in health care directives1 are exceptionally thoughtful and deserve serious attention. But, there are strong reasons for specification that also should be considered.
Physicians do not always feel able to honor patient wishes that are expressed only generally. Physicians who respect patient preferences can still get stuck— on uncertainty about just what a patient wants, or on what the law allows, or on opposition from other clinicians or the family. Specifying preferences can help resolve such problems.
Directives involve families, as well as physicians and patients. Physicians often seek family approval to withhold or withdraw life-sustaining procedures, even when patient wishes are known, and often will not honor patient choices if any family member objects. An im
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