This editorial discusses the liaison psychiatrist’s role in determining whether refusal of treatment is an act of suicide or a competent choice. This is difficult to assess in the absence of delirium or overt psychosis. It is suggested that the dynamics & affective tones of the patient’s reactions to the Health Care System as well as to family & friends are of major significance in this determination. The process of exploring these areas with patients making this choice is often therapeutic.(LN)