the patient's consent, but, often there isn't time to inform the patient, as when a life-saving procedure is required but the patient is unconscious, confused or irrational. An example is treatment for toxic psychosis. About 95% of induced abortions are being provided not because of medical indications but because patients so choose. By recommending or performing an abortion only because it is a woman's choice, physicians are demeaning themselves and their profession. If physicians deliver babies or destroy them in utero when and how patients choose, the patient becomes a customer and the physician a salesperson or a mechanic. Philip G. Ney, MD 1958 Fort St. Victoria, BC

Reference 1. Ney PG, Wickett AR: Mental health

and abortion: review and analysis. PsY'chiatr J Univ Ottawa 1989; 14: 506-516

Resuscitation of the terminally ill T | ahe articles and letters on this topic recently published in CMAJ are put into perspective by the case pending in Cincinnati, Ohio, in which an 84-year-old man is suing a hospital for resuscitating him against his specific directives to the contrary (Toronto Star, Mar. 19, 1990: 2). Although the hospital claims that the event and the outcome were "an act of God", it appears that the man's case is very strong legally. More important, he has made a point about the "right to die" in a humane and gentle manner. Medical technology is being misused especially for cardiopulmonary resuscitation in people with terminal illnesses and in frail 924

CAN MED ASSOC J 1990: 142 (9)

aged people requiring institutional care because of multiple complex and debilitating medical problems. The fact that the technology is available should not mean that it is used indiscriminately, which at present seems to be the rule rather than the exception. Michael Gordon, MD, FRCPC Medical director Baycrest Centre for Geriatric Care North York, Ont.

Making hockey safer I have one objection to the recommendations of the Canadian Academy of Sport Medicine (CASM) in their Position Statement on Violence and Injuries in Ice Hockey, as reported by Patrick Sullivan in his timely and excellent article "Sports MDs seek CMA support in bid to make hockey safer" (Can Med Assoc J 1990; 142: 157-159). I do not agree that body checking should be banned at the peewee level (ages 12 and 13) and below. I believe that elite players (such as those on all-star teams), who account for perhaps 15% or 20% of all players, should be

taught body checking techniques from the day they begin to play elite hockey. All other players, those taking part in what I call recreational hockey, should not be allowed to body check from the time they first play hockey through all levels into old-timers" hockey. We know from the statistics so well reported by Dr. Charles Tator and colleagues' that catastrophic hockey injuries occur at an average age of 17 years and an average weight of 77 kg. Waiting to introduce body checking at age 14 or, as Dr. James Sproule, chairman of the CASM's Hockey Safety Committee, suggests, 16 or 17 years is hazardous. Suddenly elite players entering the age bracket in which spinal cord inju-

ries occur are asked to change their style of play. Would it not be wiser for these players to have been taught proper body-checking techniques from the start? I was a dissenter when the body-checking policy was being formulated at the CASM meeting in Banff in March 1989, and I still am. I suggest that the CMA speak to Murray Costello, president of the Canadian Amateur Hockey Association, and John Gardner, president of the Metropolitan Toronto Hockey League, before supporting this one clause in the otherwise excellent CASM proposal. Thomas J. Pashby, MD, CRCSC 215-20 Wynford Dr. Don Mills, Ont.

Reference I.Tator CH, Edmonds VE, Duncan EG et al: Danger upstream: catastrophic sports and recreational injury in Ontario. Ont Med Rev 1988; 55: 7-12

Antibiotic therapy for acute otitis media T n he validity of the study reported by Dr. William Feldman, Ms. Theresa Sutcliffe and Dr. Corinne Dulberg (Can Med Assoc J 1990; 142: 115118) in their article "Twice-daily antibiotics in the treatment of acute otitis media: trimethoprimsulfamethoxazole versus amoxicillin-clavulanate" is questionable since no bacteriologic specimens were taken. It is very difficult to prove the efficacy of antibiotic therapy without culture results. The article is vague as to how the diagnosis of otitis media was made. Also, the reliability of the nurse's examination is questionable since the accuracy of the diagnosis was not measured by, for example, comparing tympanometry or reflectometry results with tympanocentesis results. The 95% rate of agreement be-