Edwards and Tolle are to be congratulated for bringing this sensitive issue to the forefront for discussion. However, I was struck by the absence of the nurses in the description.

In my ongoing study of nursing care of dying patients, critical care nurses describe a common scenario in which a physician writes an order for extubation and sedation and then leaves the unit. The nurse is left to deal with the technical aspects of discontinuing life-sustaining technology, providing comfort, and supporting the patient or family as the patient dies. Evidence suggests that nurses initially experience some of the same feelings as the authors express but may come to see this responsibility not as difficult or depressing, but as a caring act focused on the relief of suffering. This comes from repeatedly touching death by ministering to the patient at the bedside during the last minutes or hours of life.

Although nurses sometimes express anxiety or anger at physicians for leaving them alone with the task of withdrawing the life support and dealing with the family, they do not want to be excluded from the situation. This would rob the patient and family of the best possible care. Often the patient may live for an undetermined time after life support is withdrawn.

The authors suggest that the pulmonologist-intensivist and attending physician be in attendance and provide the technical expertise; however, this appears to be unusual. Understandably, physicians may not be able to linger at the bedside waiting for the patient to die. However, nurses express the wish that they be supported either by the physician's presence or availability as the patient goes through the process of dying.

Perhaps the best approach would be to treat each situation individually, drawing on the strengths and nature of the established relationship of each health professional, regardless of their discipline. The goal would be to make dying the best possible experience for patient and family. Nurses are likely to see death not as a failure of cure but as a "once-in-a-lifetime" experience that is of the utmost significance for each individual and should be treated with respect and caring attention. In this context, the comprehensive care of a dying patient should be a priority for all concerned.