I read with interest Gilligan and Raffin's perspective on the death of an elderly patient who had cardiac arrest after sustaining a cerebrovascular accident [1] and the accompanying essay by Hansot [2].

Although I am sure we would all agree that this is a very difficult problem with which we all wrestle, I object to Gilligan and Raffin's rush to judgment in this case. Because Dr. Hansot is also a professor at Stanford University, I would assume that both the authors had probably discussed details of her mother's case with her. If the authors were going to make such sweeping and dogmatic judgments about the attending physicians, they should at least have given the attending physicians the same opportunity to voice their perspective and opinions. Failure to do so, in my opinion, reduces many of their conclusions to partisan emotional rhetoric.

These two articles indicate that there was a failure in communication. The best way to have communicated the patient's wishes expressed in her advanced directive and power of attorney was to have made the living will part of her hospital record. It can be argued endlessly as to whether it is the patient's, the physician's, or the hospital's responsibility to make this a part of the permanent record. However, it could also be said that this responsibility should be shared equally among all of the parties in question.

If Gilligan and Raffin believed that discussing the legal ramifications of withholding care was beyond the scope of their article, then the same sweeping judgments that I have referred to above should not have been made. Any physician who has been in this situation before would readily admit that these legal issues do weigh heavily on a decision of this type.

Another thing that could be learned from Dr. Hansot's essay stems from Dr. Hansot's statement that she was ill-prepared for this event. This is certainly understandable, but it is also entirely possible that this lack of preparation may also have led to the breakdown in communication.

Articles that present an unbalanced view of such emotional and difficult issues do nothing to resolve these difficult problems. In fact, they probably make arrival at a satisfactory conclusion all the more difficult.