No, I am not talking about people who commit suicide or wish to be euthanized. I'm talking about people like my patient. Joe (as usual I've changed the names and identifying details). Joe was eighty-five and suffering from Alzheimer's Disease. His wife, Peg, had been caring for him at home but Peg was getting older herself and feeding, bathing, and otherwise looking after a man twice her size was wearing her out. Their children worried that the strain would make Peg sick. They also worried that as Joe's condition deteriorated further he might become a danger to himself or others by wandering, leaving a stove on, or getting behind the wheel of a car. It was time to reconsider their living situation. So Joe and Peg came to see me along with their son, Jim. Joe was immaculately dressed, as always, clean shaven with his hair neatly parted and combed. He sat straight in his chair and listened attentively as Jim and Peg told me the options they had considered: adult day care, round the clock aides, a nursing home. Joe's wife and son did not wish to have this discussion out of his hearing. Joe had always been a proud and dignified man and it seemed only right that he continue to be treated like a person, a person who had the right to hear his fate decided even if he could not participate in that decision. Periodically I turned to Joe and asked him how he felt about what was being said and he simply smiled and nodded. The family left my office without a specific plan but agreed that something would have to change. Joe and Peg could not continue living independently. Two days later, Joe died in bed. Had he somehow decided to spare his family the agony of his progressive illness? Doctors are uncomfortable with such conclusions. Even when we are unable to make a definite diagnosis we assign a cause to death that places (except in cases of suicide) the patient in a passive role. In our desire to establish a cause of death we may speak of "failure to thrive," or " heart failure" but, really, doesn't everyone die of those things? Yet, all doctors have seen patients like Joe who seem to have decided that the end of their lives has arrived and, against the poet Dylan Thomas' famous admonition, they do, as Joe did, "go gentle into that good night."