The letter by Dr. John J. Quinlan to Dr. William A. Cook, despite its omission of important clinical details, raises serious questions and concerns. We are then told, without further explanation, that the patient is now perfectly well and 85 years old. Cook's response misses several key points.
Good ethics follow from good medicine.
An appropriate and sequential neurological evaluation of the patient would have provided some clues about the eventual outcome for this patient. In the second case, in which a man 42 years of age stated that he did not want to be resuscitated, the question is strictly one of the patient's competence. A competent patient has the right to refuse any treatment. If indeed the patient is found to be incompetent because of clinical depression, then he should be assessed and treated for his psychiatric condition, and his family should be involved in his care. Granted, I omitted the clinical details of the unexpected survival of my patient in the first case.