Mary's husband feel supported in the decision to let her die naturally. They also put him in touch with the palliative-care team, which provided him with spiritual and emotional support while ensuring that Mary was kept comfortable and didn't suffer.

Jerry, a 14-year-old boy, is terminally ill with end-stage metastatic T-cell lymphoma. He's been told that he has cancer but not that he is dying. His caregivers feel nothing more can be done for Jerry and they recommend that he receive only comfort care. His mother agrees but won't challenge her husband, who insists that Jerry continue to receive curative care and that he not be told he is dying. Jerry's caregivers call for an ethics consult.

During the group meeting, Jerry's parents, who are Asian, explained that according to their cultural mores parents make all decisions for their children. They also pointed out that sons have special significance in their culture and that Jerry was their only son. They were confident that God would work a miracle. The nurses and doctors explained that they cared very much about the boy and were worried that further aggressive treatment would be more likely to harm him than help him and would cause him to suffer unnecessarily. It would be best, they said, to provide care that would ensure the boy's comfort. They also felt strongly that Jerry should be told he was dying.

With support from members of the ethics consult team, the father was eventually able to recognize that the treatment he was asking for would not promote his son's comfort and that the staff truly had Jerry's best interests at heart. When the boy was finally told the full extent of his

Bill Edwards: Ethics questions "almost by definition" have no clear answer

In 1990, Dartmouth received a National Institutes of Health grant for the first comprehensive study of the ethical implications of the Human Genome Project; the investigation was led by philosopher Bernard Gert.

Since it was likely Sharon would continue to use marijuana, should she still be encouraged to breast-feed? On the one hand, neonatologist Bill Edwards noted, breast milk is superior to formula. But on the other hand, could it offer more harm than benefit in this case?

illness, he wasn't surprised. Instead, he had been worried about how his parents were doing and had been trying to protect them.

"Sometimes an ethics consult can break this logjam where people are stuck," says Plunkett. The ethics consultants are careful, however, not to overwhelm patients and families with too many new faces and will sometimes spend most of their time meeting with the care team, coaching them on how to communicate effectively with patients and their families.

All ethics consults are also discussed by the entire committee, usually once the issue has been resolved. A few days after its resolution, Jerry's case was presented at a meeting of the full Ethics Committee. Such discussions are viewed as educational, and committee members are encouraged to ask questions and express their own views, even though the question may be moot by then.

"Do parents have the right to tell doctors not to talk to their children about their medical care?" Bernat asked during this particular meeting. A lively exchange of views ensued.

"Is there some guidance on this?" asked another member.

There is, Bernat explained. In 1995, the American Academy of Pediatrics' Committee on Ethics published a statement asserting the right of older children and teenagers to be involved in the medical consent process regarding their own care.

Sharon is 22 and has just had a baby; her premature newborn is in the intensive