Dr. Harrow's anger was initially very discomfiting, but I believe his emotion suggests that my story was successful; it has stimulated discussion. Therefore, I thank him for voicing his opinions. I'm not entirely sure where his anger is directed, but I think it is directed at me.

At the risk of responding too superficially to the issues raised, I feel three important concepts bear pointing out: 1) Motivation was neither ethnic, racial, political, or religious; 2) there was a question of whether this patient had the capacity to make a decision about his health care; and 3) agitated, intoxicated, or delirious patients are often physically or chemically restrained against their will. I would remind Dr. Harrow that overzealous criticism and an inability to see issues, except in a polarized "black or white" fashion, were characteristics of both the Third Reich and the Soviets. When issues collide [like autonomy versus capacity or "medically right" versus "socially right"], there is rarely a totally satisfactory solution. At the simplest level, medical "mistakes" happen, usually without malice, and often with the best intentions. Acknowledging them may help people in at least two ways: 1) Knowing about others' "mistakes" enables us to be a little easier on ourselves, and 2) even if you've never been part of a "mistake," maybe a similar situation will come up for you in the future and you can be better prepared.

Dr. Harrow might read the story again without misassigning motivation. This is just one illustration of a difficult dilemma that is common and bears airing, judging from several letters I have received. I honestly don't know what the "right answer" is for a patient or situation like this; I doubt I ever will.