To the Editor.
—The data presented by Fox and Stocking1 are insufficient to justify the authors' broad conclusion that there is "wide variability in ethics consultants' recommendations." The vignette used in the study lacks many of the factual nuances necessary for a consulting ethicist to form an appropriate recommendation. We can think of no consultant who would be willing to make an actual recommendation based on such simplistic information. For example, an ethics consultant must know much more than just the fact that the patient has an advance directive (AD) and that the family wants "everything done" (variation 2). Without additional specific information, the survey respondent could assume that the AD is valid and that the family's requests are based on an irrational or emotional reaction, or just as likely, the respondent could assume that the AD was signed (as many are) when the patient was only marginally competent
Moseley R, Van McCrary S. Variations in Recommendations of Ethics Consultants. JAMA. 1994;271(18):1403. doi:10.1001/jama.1994.03510420035026