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Having faced the situation described in "Questions Concerning the Goodness of Hastening Death" (May 2006: 312–314) the very weekend I read the article, I had a vehement reaction to it. The author seemed to assume that patients, families, and health-care providers function at a level of ignorance that can be overcome only by research and advanced degrees. True, many people are unable to talk about death before they’re confronted with a life-threatening illness. But many patients and their families incorporate religious beliefs, cultural mores, knowledge about their disease process, and personal values into decisions about how death should be approached.

As a patient advocate I strive to develop relationships with patients and their families that will make me privy to the process by which decision making occurs, without imposing my own beliefs. As I have become more experienced at the bedside, I have rethought calling certain actions "withdrawing care" and identified actions as interventions in the face of redirection of the plan of care. In end-of-life circumstances, I reassure families that the intensity of care will not change, even if the goals of care do.

The minute-by-minute, hour-by-hour family experience of death cannot be dissected by a cerebral dialogue like Pascal’s Gamble. After 30 years of nursing, mostly in critical care, I feel that no death has ever been the same. The tone of this article devalues knowledge gained from experience, and the rhetoric certainly depersonalizes this basic human event.

Cynthia Stock, RN, MSN, CCRN
Garland, Tex

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