The three cases reported by Luce2 are equally difficult, involving patients who had injuries that were self-inflicted, or were inflicted by another person, who presented to a public hospital for care, and therein attempted to limit the care that the intensivists/surgical team could provide. The first patient refused further therapy after surgery for a self-inflicted gunshot wound to the chest. After her condition initially improved, she later developed an hepatic abscess, became septic, required a surgical intervention, developed multisystem organ failure, and, after intervention by friends, was allowed to die. The second patient, after recovering from multiple abdominal stab wounds, developed a small bowel obstruction, refused insertion of a nasogastric tube and the performance of a second laparotomy, developed respiratory failure, refused intubation, was brought to the surgical ICU, and, after much discussion and debate among the surgeons, intensivists, and psychiatrists (with the latter called in to help negotiate a compromise between the former pair), the decision was made to take the patient to the operating room, even though he had refused therapy, because, having stayed in the hospital, it was determined that he likely wanted to live. On day 3 postoperatively, he was in multisystem organ failure, therapy was withdrawn except for the administration of analgesics, and the patient was allowed to die. Patient three had a cervical spinal cord infarction that resulted from IV drug abuse. He was quadriplegic and had proved unable to be weaned from mechanical ventilation. This individual asked that all therapy, except analgesia and sedation, be discontinued, and that he be allowed to die. His reasoning was that he did not want to received ventilation or live as a quadriplegic. This course was followed. However, the patient did not die immediately, and, even in face of an ethics committee recommendation to discontinue the course of sedatives/analgesics and to allow the patient to awaken to determine whether he still wanted to die, the IV agents were continued, and the patient died 48 h after the ethics committee consultation.