The problems with precision and neutrality

Kamm describes eliciting patients' values via precise and balanced trade-off questions, with increasingly specific follow-up questions used to pinpoint patients' wishes and ‘avoid mistakes in EOLC decisions’. This approach does not resonate with our experience conducting EOL conversations with seriously ill patients and, we would argue, it risks biasing preference elicitation for different reasons.

First, Kamm's model assumes that people have preformed preferences for EOL treatments. She suggests that the goal of the interview is to elicit these preformed preferences in a way that lets the ‘truth’ come out. In contrast, we argue that preferences are discovered in conversation, a process in which patients reflect on …