Dr. Wynia's account of how he had convinced the attending physician of a dying patient with liver failure not to institute cardiopulmonary resuscitation (CPR) despite the instructions of the patient's wife to "do everything" expresses a laudable ethical stance but seems to place the physician in a difficult legal position. Although the best interest of the patient was the clear impetus for the author's actions, certain legal decisions recently have placed physicians who would follow Wynia's lead in a precarious position. Take the case of Baby K, an anencephalic infant whom physicians wanted to remove from life support because they felt it served no purpose but whose mother insisted that the treatment be continued. The physicians were rebuffed by the courts, who upheld the mother's right to insist that everything be done to keep the infant alive. In another well-publicized case, an elderly woman in a persistent vegetative state was kept alive by mechanical ventilation. The courts upheld the husband's right to insist that this care be continued, over the objections of the patient's physicians on the grounds that such treatment was futile. She died a few weeks after the judgment was issued.

Some would say that cases concerning withdrawal of life support cannot be compared with the situation described by Dr. Wynia because that case involved the withholding of CPR. I feel, however, that these cases are comparable, given that both situations involve the use of heroic measures and given that both decisions are generally felt to require the consent of the nearest relative. Apparently, the law supposes that the family of a critically ill patient is always in the best position to make decisions regarding that patient's care. But, as Charles Dickens noted in a slightly different context, "If the law supposes that, Sir, then the law is an ass." And unless there is some legal relief from this condition, most physicians will probably continue to "do everything" if the family so instructs, regardless of whether or not they feel it is in the patient's best interest.