… “Why do we make potentially inefficacious therapies the default and require patients to opt out to avoid them?” … asks Brauner in a JAGS editorial accompanying an article on comfort feeding.
“By creating an alternative treatment order—comfort feeding only (CFO)—Palecek and colleagues1 have taken an important step toward improving the care of persons with advanced dementia and rectifying the problem of continued overuse of percutaneous enteral gastrostomy (PEG) feeding tubes. By intentionally changing the usual advance directive scenario, the authors suggest the possibility of improving care for gravely ill and dying patients, but this possibility cannot be fully realized unless we also examine the advance directive paradigm in which the CFO operates—and that Palecek and colleagues do not challenge. If we can then apply this knowledge to move beyond the current paradigm, we could transform care for the legions of patients who suffer from the default application of burdensome, inefficacious therapies because of the contingencies of custom.” (Brauner, D. J. (2010), Reconsidering Default Medicine. Journal of the American Geriatrics Society, 58: 599–601. doi: 10.1111/j.1532-5415.2010.02743.x)