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[The authors respond:]
Thaddeus Pope rightly points out that our patient's living will1 was a standard one that has appeared in several publications, including this journal.2 Although his living will was professionally prepared using a standard template, our patient had to choose this document and its language over another living will that may not have adequately reflected his life situation and views at the time.
Pope also raises a more important issue, which is the need to focus on the appointment of substitute decision-makers to properly convey the wishes of a patient when he or she is unable to articulate his or her own wishes. The increase in the use of living wills is certainly beneficial, but an informed substitute decision-maker must assume the responsibility for taking the broad language of the living will and applying it to the current situation of the patient.
As pointed out by Pope, the language of the living will we presented in our Left Atrium article does not clearly indicate the patient's preferences because it is impossible to prepare for all clinical situations. This living will was an important first step in ensuring that proper discussions took place with our patient's immediate family regarding the appropriate level of intervention at the end of his life. Ideally, this is the role the living will should play: it should be the starting point for productive discussions with the patient's family and should afford the patient a voice when he or she is not able to speak for himself or herself.
Footnotes
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Competing interests: None declared.
REFERENCES
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