The essay by Hansot [1] highlights the importance of recognizing the need to limit intensive medical interventions when they would only prolong the dying process and inflict unintentional cruelty. Dr. Hansot implies that she would have been more satisfied if the decision to withdraw life support had occurred earlier than her mother's fifth day of hospitalization.

As a senior resident, I hospitalized an elderly woman who had had a massive myocardial infarction. Her condition deteriorated steadily, with a decrease in arterial blood pH and bicarbonate and an increase in lactate levels. Our teaching service and the consulting cardiologist believed that further treatment in an intensive care unit was futile, and they recommended that the patient be transferred to a hospice. The patient's four daughters, however, insisted that everything possible be done. The patient was unresponsive and was unable to voice an opinion.

We spoke to the daughters daily to explain the gravity of their mother's condition. Because they refused to allow the transfer to the hospice, we continued maximal medical therapy for the patient's cardiogenic shock. After several weeks in the intensive care unit, the patient improved enough that she was transferred to a nursing home, where she died a few months later. During this time, she remained in class IV congestive heart failure and was unable to dress or care for herself.

I was notified 20 months later that the patient's daughters had filed a complaint with the Medical Examining Board that stated that they planned the patient's funeral on the basis of our bleak prognosis and that alleged that our daily discussion amounted to undue pressure. The residency program's general counsel represented the three physicians named in the complaint, but one could imagine a scenario in which a physician would have to retain separate legal counsel, probably incurring significant expense.

Clearly, withdrawing intensive care treatment in futile situations is not as simple as Hansot imagines and may pose important risks to the treating physicians.