I am pleased the defendant won this case (“Amputation results from diabetes,” June 2010). Exactly how far do health-care professionals have to go before it is acceptable to say, “I have done as much as I can for this patient?” I recall a case in which a hypertensive patient suffered a cerebrovascular accident because he refused to take his meds. Fortunately, the chart showed extensive patient education and documented constant reminders. Another case I was part of involved a patient who continued to smoke after a laryngectomy and had a recurrence three years later. At the risk of sounding unsympathetic, there is a limit to just how much clinicians can do. At some point, the patient and family are responsible.—HARRY PLUMMER, RN, PhD, Calgary, Alberta (142-9)