Boston Betty is so right about pain control. Many doctors are afraid of getting in trouble if they use too many narcotics; others are afraid of addictive problems. Regardless of the reason, if you find yourself with a doctor who won't control your pain get to a pain specialist. Betty is a little cynical about the reason for doing CPR. Doctors have had threats of criminal charges for not doing all they can to prolong life. One never knows which nurse is an overzealous "right to life" type who will report a doctor. Today, every patient's wishes regarding CPR is recorded as they enter the hospital by federal law. Those wishes must be obeyed. As a routine, I discussed with my patients (before they were anywhere near death) their views on end of life care. Most patients said that they did not wish to have life prolonged by artificial means (and I personally feel the same way about my own life). I have had the situation occur where patients of mine ended up on life support, but were conscious and alert. I asked them if they remembered our discussion and they all nodded yes. I then asked if they still felt the same way. Almost all chose to continue to fight to live despite their earlier views while healthy. Evidently, they had not reached the point of having had enough. When the few patients reach that point where they wish to end their suffering, there must be a way for doctors to help them fulfill their wishes and end their suffering painlessly. Although we all say, "well I would do such and such," in that situation we cannot truly be sure until we are there. This is a decision which must be left to the individual, but the doctors should have final say. I have also encountered a situation where the adult children wished life support removed from their critically ill comatose mother (when I didn't) where the disagreement reached the point where one son threatened me with getting lawyers evolved to allow his mother to die. For five years afterward, that woman invited me to her birthday parties where she lovingly and humorously chided her son about trying to do her in. The patient deserves a great deal of control, but the doctor provides knowledge. "Terminal" must be defined. Life is a "terminal" disease; we are all going to die. In "easy" cases where someone has cancer and is in a great deal of pain as death rapidly approaches, control belongs completely in the hands of the patient. In other, less clear situations doctors should have the final say. No doctor should be forced to help a patient do what he does not agree with.