Paterson's article sings the now very familiar song of the abuses of medical technology. She describes "hopeless cases kept alive for no reason" and easily dismisses the care rendered by the medical community as technologically based rather than humanitarian.
Her article, however, says nothing new.
In the university hospital and throughout training we are very well instructed in withholding care. But care must be dictated by the patient, working with his or her physician. The family frequently has another agenda which must, in a patient-oriented system of care, remain secondary.
The ethical issue for the 1990s may not involve the excesses of medical care but premature cessation of care based on statistical considerations and fiscal concerns.
Finally, we must be very careful that our concern for terminally ill patients, who are unable to speak for themselves, be supportive. Complacency becomes a great threat against which we must battle both with judicious technology and human concern.
GARY SCHILLER, M.D.