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Gabriel T. Bosslet, MD; Mary S. Baker, MD; Thaddeus M. Pope, JD, PhD
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FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

aDepartment of Medicine, Indiana University, Indianapolis, IN

bSentara Pulmonary, Critical Care and Sleep Specialists Sentara Healthcare, Norfolk, VA

cMitchell Hamline School of Law, St. Paul, MN

CORRESPONDENCE TO: Gabriel T. Bosslet, MD, 1120 W Michigan St, CL285, Indianapolis, IN 46202


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(6):1426. doi:10.1016/j.chest.2016.09.045
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We appreciate the comments by Rady et al regarding our analysis of the importance of legal reason-giving in the social discourse surrounding disputes regarding discontinuation of life-prolonging treatments. We make three points in response. First, they point out that considerable and informative reason-giving was provided by Vacco v Quill and Washington v Glucksberg. This is true, and these cases have cast a considerable judicial shadow over the debate regarding medical aid in dying. However, these cases are outside the scope of our analysis, which focused on nonconsensual recommendations to forego further life-prolonging treatments.

Second, we also agree with Rady et al that the McMath case is one that could challenge the medical profession’s previous experience with brain death. It is possible that a ruling that nullifies her death certificate would shape social discourse regarding brain death for some time, which comports with our rough analysis of the effects of such decisions. However, any long-lasting change to the wider clinical guidance regarding brain death would likely come from subsequent legislative or judicial challenges to the Uniform Determination of Death Act.

Third, Rady et al suggest that legislative initiatives are likely to have a larger effect on social discourse than judicial ones. We agree with this assertion—legislatures tend to have more time and resources to carefully weigh resolution processes. Legislation is, by nature, of an ex ante nature. Furthermore, we would contend, legislative efforts that entail case-by-case reason-giving (ie, Ontario’s 1996 Health Care Consent Act, which established the Consent and Capacity Board) would provide considerably more utility for social discourse and wider clinical guidance than those that avoid required reason-giving (ie, the Texas Advance Directives Act).

References

Bosslet G.T. .Baker M. .Pope T.M. . Reason-giving and medical futility: contrasting legal and social discourse in the United States with the United Kingdom and Ontario, Canada. Chest. 2016;150:714-721 [PubMed]journal. [CrossRef] [PubMed]
 
Vacco v. Quill, 521 U.S. 793 (1997).
 
Washington v. Glucksberg, 521 U.S. 702 (1997).
 
Luce J.M. . The uncommon case of Jahi McMath. Chest. 2015;147:1144-1151 [PubMed]journal. [CrossRef] [PubMed]
 
Ontario Health Care Consent Act, SO 1996, §C2, Schedule A (1996).
 
Texas Health and Safety Code § 166.046.
 

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References

Bosslet G.T. .Baker M. .Pope T.M. . Reason-giving and medical futility: contrasting legal and social discourse in the United States with the United Kingdom and Ontario, Canada. Chest. 2016;150:714-721 [PubMed]journal. [CrossRef] [PubMed]
 
Vacco v. Quill, 521 U.S. 793 (1997).
 
Washington v. Glucksberg, 521 U.S. 702 (1997).
 
Luce J.M. . The uncommon case of Jahi McMath. Chest. 2015;147:1144-1151 [PubMed]journal. [CrossRef] [PubMed]
 
Ontario Health Care Consent Act, SO 1996, §C2, Schedule A (1996).
 
Texas Health and Safety Code § 166.046.
 
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