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To the Editor: Dr Schneiderman and colleagues¹ concluded that their ethics intervention reduced the number of nonbeneficial ICU days in patients for whom value-related treatment conflicts arose. However, the authors did not directly assess important outcomes that may have been affected by the ethics intervention, such as family satisfaction with ICU care or with the decision-making process. It is unclear whether the families of patients who received ethics consultation were less satisfied than families in the control group. The excess ICU length of stay in the control group may have been nonbeneficial in terms of the prolongation of life, but may have been very beneficial in terms of family satisfaction with the dying process or of gaining a sense of closure with their loved one. Although we agree that the number of "nonbeneficial" days may provide some information about the quality of care provided, we believe that the most important . . . [Full Text of this Article]

Douglas B. White, MD; John M. Luce, MD
Division of Pulmonary & Critical Care Medicine
University of California, San Francisco

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