Ethical Problems in the Medical Office

To the Editor.—  Congratulations to Connelly and Dalle-Mura¹ for their article entitled "Ethical Problems in the Medical Office." Their assessment of the significance and frequency of outpatient clinical-ethical problems is both accurate and timely. Also accurate is their assessment that, very often, these problems are dismissed as "trivial when compared with hospital problems."Unfortunately, these very same "office problems" are the ones that become "hospital problems" given enough time. Just as preventive, primary health care is not as exciting—and not as well funded—as intensive care unit medicine, preventive, primary ethics is not as glamorous and not as well practiced as in the intensive care unit. But just as untreated hypertension may lead to a stroke, untreated issues of competence and refusal of treatment may lead to a useless resuscitation or persistent vegetative state. Too bad for all of us.One way around this might be to encourage the inclusion