I read with interest the article by Edwards and Stolle [1] and felt great sympathy for the physicians. To usher people comfortably out of life is an important part of the physician's job. This ideal is often agreed to in principle but is often not fulfilled in practice.

It appears that, after careful planning, the specialist and the attending physician delegated this delicate task to an intern. There is no one to whom such a responsibility should be shifted, especially an unattended trainee.

The authors appeared to require the concurrence of all family members in the decision to disconnect the ventilator. It is in no way incumbent upon a competent patient refusing to accept further medical treatment to convince all his family members that his is the right choice. It is more convenient if everyone agrees and perhaps, if disagreement had been present, appropriate counseling might have been offered. Physicians do "have an obligation to verify that the refusal of life-sustaining treatment is the durable request of a mentally competent, well informed patient". It is all too common in geriatrics that a competent person has taken the trouble to make known his or her wishes in the form of advance directives. Most such directives ask that certain types of invasive therapies be foregone; however, when the person is no longer able to speak for him- or herself, these wishes may be countermanded by a family member (known in the east as "the son from California Syndrome").

The law appears to support compliance with the patient's directives, whereas practice often does not. I hope that your article will not be misconstrued as supporting requirement of family consensus in these decisions.