I read with interest the essay by Hansot [1]. The author's mother was placed on mechanical ventilation after a stroke, even though she had a properly executed living will and her daughter had a power of attorney for health care and general power of attorney. An incident involving two of my good friends further illustrates the problem that hospitals and their intensive care staff face with regard to terminally ill patients on ventilators.

An 84-year-old retired family practitioner and anesthesiologist had chronic arthritis for which he was receiving self-regulated steroids. He was a lifelong smoker and had clinically significant obstructive pulmonary disease, yet he was able to ski an hour or two a day each day during the season and play golf in the spring. Within the past year, he developed an overwhelming pneumonia with a compromised immune system and had to be admitted to the intensive care unit. He was immediately put on a ventilator, despite the objections of the family, one of whom was a staff nurse. He remained on the ventilator for several weeks. After a consultation with a very good friend of the patient, a physician retired from the staff, it was decided that the family would request that the patient be discharged to his home but still be supported by the ventilator. This request was approved. Soon after the ambulance left the hospital grounds, the close friend was allowed into the ambulance, where the endotracheal tube was removed. By the time the patient reached the front door of his house, he was dead.

Even the living wills of persons who are retired hospital staff members can be disregarded. This just emphasizes the difficulty faced by lay persons who are presented with situations similar to those described in Hansot's essay. I do not pretend to know the answer to this perplexing problem.