To the Editor.
—I read with interest the article on cost savings at the end of life by Dr Emanuel1 because of a personal experience. My father had chosen 2 years ago to die with the support of a hospice program.I suggest to the author that the point at which to begin comparing the costs of hospice and nonhospice care is when it is necessary to make a decision for intervention in order to sustain life. Care that has as its primary purpose to sustain life, rather than the primary purpose of providing comfort and relief from pain and discomfort (even if it prolongs life), would be the criterion for exclusion from the hospice group.I take issue with the author's suggestion that the indirect cost of a family member's care should be considered in the cost of hospice care. I do not believe that it is factored