To the Editor.
—The article by the SUPPORT investigators1 is a terrible testimony to the inertia of physicians regarding the use of advance directives and respect for autonomy. What has to happen to get physicians to realize that these issues are important, to accept the reality of patient wishes, to understand that patient rights include the patient's ability to decide on what treatment to accept or decline, and to recognize that the physician's responsibility includes initiating the discussion of these concepts?2It would seem we have taken several steps backward into the era that existed when I first began practice nearly 40 years ago. Physician paternalism was rampant and accepted as right and customary. Nobody questioned the physician's decisions and orders. Over the years, this slowly changed, and we thought we had witnessed the dawn of an acceptance of a partnership in the patient-physician relationship. Mutual respect, mutual