To the Editors:

In the article titled “Synergy Model and the Role of Clinical Nurse Specialists in a Multihospital System” (September 2002:436–446), I found the role of the clinical nurse specialist interesting in coordinating the care of Mr F, who suffered complete paralysis after a motor vehicle crash. How wonderful to have such an intelligent, talented, and resourceful support person.

There are great concerns in my intensive care unit, however, regarding the policy described requiring patients to be assessed by 2 independent psychiatrists to determine competency. This seems to be the exact scenario that contributes to peoples’ frustration with regard to advance directives (ADs). The man had executed his ADs with specific instruction regarding paralysis; he did this when he had decisional capacity, so that his wishes would be carried out in the event he lost that capacity. Why,...

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