None of the commentators [1] on the anguish of physicians Edwards and Tolle [2] criticized how they behaved as ethicists in the care of "Mr. Larson," the manner in which they were invited to participate in his care. I write to mention a possible grave error made in the care of this patient, whose desire to forego life-sustaining treatment should not have been honored. The U.S. Supreme Court's decision regarding Nancy Cruzan legally established that a competent adult has the right to refuse all life-sustaining treatment, including artificial nutrition and hydration. An ethical argument, however, can be made that such a patient not only has responsibilities to himself or herself but also to his or her family and, in a larger context, to society. Therefore, patient autonomy does not absolutely trump family and societal needs. For Mr. Larson, however, this does not seem to be true.

What is troublesome about this case is the fact that Drs. Edwards and Tolle exceeded their moral responsibilities as ethicists. The ethics consultation was probably initially sought to examine and offer an ethical opinion about the termination of life-sustaining treatment in a competent adult who had not been diagnosed as being in a terminal state. Part of an ethics consultation is to aid in decision making. Once a decision is reached, it is the responsibility of the attending physician to determine whether he or she can morally honor the decision and, if so, then implement the decision. It is not ethicists' responsibility to implement the decision [3]. Ethicists should offer moral support to the clinicians implementing the decision. The reason why Edwards and Tolle were forced into withdrawing ventilatory support from Mr. Larson was a lack of communication during the process of the ethics consultation.