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In response to: Withdrawal of life-sustaining treatment in the first year of life

Journal of Perinatology volume 29, pages 327–328 (2009)Cite this article

In describing their experiences that deal with medically inappropriate interventions since the enactment of the Texas Advance Directives Act, Eason et al. (September 2008 issue)1 describe six patients who underwent withdrawal of care as outlined by the Texas Advance Directives Act. This article provides a good overview of the Texas Advance Directives Act in practice, the rarity with which it is invoked, and the outcomes of representative cases. The authors conclude, in part, that ‘a major part of the solution to these conflicts lies in improved communication.1’ This conclusion suggests that communication gaps or breakdowns played at least some role in these extraordinary cases, though the authors do not explore in detail the nature of these presumed communication gaps.

The authors go on to state that ‘There was no evidence that other considerations such as insurance status, socioeconomic status, race, or gender played any role in bringing the cases to the MARC, or in the resulting decision of the MARC.1’ However, it is striking that all six patients reviewed in this report were minorities; one infant was Hispanic and the other five were African American. The authors appear to omit from their conclusion the possibility that racial and ethnic differences may be a barrier to effective communication between clinicians and patients/families. Such potential communication gaps and challenges have been earlier explored and documented in the literature.

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Authors and Affiliations

  1. Division of Pulmonary, Department of Internal Medicine, Allergy, Critical Care, and Occupational Medicine, Indiana University Medical Center, Indianapolis, IN, USA

    G Bosslet

  2. Division of Hematology/Oncology, Department of Medicine, Indiana University Medical Center, Indianapolis, IN, USA

    P R Helft

  3. Indiana University School of Medicine, Indianapolis, IN, USA

    G Bosslet & P R Helft

  4. Charles Warren Fairbanks Center for Medical Ethics, Clarian Health, Indianapolis, IN, USA

    P R Helft

Authors
  1. G Bosslet
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  2. P R Helft
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Correspondence to G Bosslet.

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Bosslet, G., Helft, P. In response to: Withdrawal of life-sustaining treatment in the first year of life. J Perinatol 29, 327–328 (2009). https://doi.org/10.1038/jp.2009.6

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