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To the Editor: In their article on conflicts regarding decisions to limit treatment, Dr Goold and colleagues¹ do not mention a scenario that I have faced a number of times in caring for patients with chronic neurological diseases. This might be called the proud caregiver syndrome. The caregiver's entire life is centered around the patient. The caregiver gains respect, pride, a sense of noble self-sacrifice, service, and accomplishment from his or her caregiving. Life would become meaningless without the individual to whom he or she can administer care. The decision to continue all-out efforts is based on the need to continue the caregiver role, rather than on the patient's wishes or needs.

We are not told much about the son and daughter-in-law, the individuals who are pushing aggressive care in the patient example given in the article. This might be a possible reason for their behavior.

Louis R. Caplan, . . . [Full Text of this Article]

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