The study by Schneiderman and coworkers [1] is important because it was prospective and multidisciplinary. However, the results should be viewed cautiously. The research was completed nearly 2 years before the Patient Self-Determination Act was implemented, requiring that patients be advised at the time of hospital admission of their right to execute an advance directive. Few would deny that the inpatient setting is a suboptimal place to begin an initial discussion of discontinuation of treatment. However, the authors seem to imply that such issues should be excluded from hospital discussion simply because they have been previously raised during outpatient encounters. It is curious that the multidisciplinary, prospective evaluation was apparently terminated in favor of a retrospective approach when the study patients were hospitalized. The rationale for this decision is not immediately clear. If the prospective approach had been extended, additional important information on patient attitudes might have been obtained. In addition, the advance directives themselves might have been modified if members of the outpatient interview team, who had already established a close provider-patient relationship, were available for inpatient consultation. A written directive, or the deliberate decision not to execute one, is an opinion expressed at a point in time and may be subject to change under different circumstances, including hospitalization.