All patients (n = 30) undergoing the terminal withdrawal of MV at the New England Sinai Hospital LTACH in Stoughton, MA, from April 1, 2005, to March 31, 2007, had been identified at the time of withdrawal as part of quality assurance to confirm appropriate decision making regarding the withdrawal of MV. A retrospective review of the medical records of these previously identified patients was performed. The following data were abstracted from the electronic and paper medical records using a standardized data collection tool: patient demographics, medical history, cause of respiratory failure, advanced directive decision making, weaning attempts, duration of hospitalization, timeline of decision to withdraw MV (days elapsed from initiation of MV at the acute facility to the following events: admission to LTACH or MICU, do not resuscitate [DNR] decision, comfort measures only [CMO] decision, decision to withdraw MV, and death). The cumulative dose of narcotics and benzodiazepines used in the 1-h period before and the 1-h period after the terminal withdrawal of MV and also during the 24-h period before death were calculated and expressed in equivalent doses of morphine sulfate and lorazepam, respectively, using a dose-equivalent conversion method. Participants in the decision-making process (ie, patient, family members, medical staff, social work, nursing staff, pastoral care, and hospital administration) were identified from the record. The cause, date, and time of death were determined from the death certificate.