Decision making in near death

To the Editor: As a pediatric hematologist-oncologist I have intimate knowledge of the territory Ms. Wolf discusses (Jan. 18 issue).* Most of my patients are competent, but because they are minors, proxy decision making is the rule rather than the exception. Her comment that all decisions about life-sustaining therapy belong to the patient is an oversimplification. I suspect that she shares the lawyer's preference for absolutes (“clarity”) and finds comfort in adversarial proceedings when there are multiple imperatives. In fact, decision making by consensus is really not such a bad idea. There are two situations in which it is particularly.