Elisabeth Hansot's sad tale [1] and Gilligan and Raffin's incisive analysis [2] were most moving. But may I suggest that all might have decided too hastily that the mother's death was justified? It seems plausible that failures in communication as well as problematic therapy may have contributed to the patient's premature death, as well as to unnecessary suffering on the part of mother and daughter.

How often can one be so confident within the first 24 hours to predict lack of recovery, need for a permanent tracheostomy, and need for placement in a nursing home? Such a barrage of devastating news presented to a previously healthy person can obviously lead to despair.

I wonder, too, why one must, on the first day of treatment, impose the discomfort of a nasogastric tube in addition to an endotracheal tube. Inadequate sedation and lack of compassionate, calming conversation also seemed to aggravate the patient's distress. Because the patient was conscious and alert soon after the stroke (which suggests rapid progress), why was there talk about a permanent tracheostomy?

Had the possibility of rehabilitation (the ability to return home without a tracheostomy) been presented, perhaps neither mother nor daughter would have demanded prematurely that the mother's life be terminated.

Hansot's story indicates once again that communication failures not only cause anguish but may contribute to major illness and even death.