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When resuscitating a patient who suddenly became breathless and pulseless, the physician generally assumes that the cardiorespiratory arrest was precipitated by serious heart disease. In the vast majority of cases, the assumption will prove to be correct. The ECG or, if resuscitation fails, the autopsy will disclose evidences of underlying pathology in the myocardium, the coronary vasculature, or the conducting system. Occasionally, however, no such pathology will be found. Classic examples are crib deaths and "near deaths," which still defy explanation. Whatever their cause, no cardiac lesions serious enough to account for the sudden death have been found in the stricken infants.Recently, a variant of cardiorespiratory arrest that could not be accounted for by a cardiac lesion has been described by several observers. Lloyd-Mostyn and Watkins1 reported unexplained cardiorespiratory arrests in two diabetic patients with autonomic neuropathy. In a later and more extensive study, Page and Watkins2 noted 12 such arrests in eight young diabetic patients during a period of five years. These patients, six of whom were women, had had diabetes for four to 32 years. They all had various complications and one or more of the florid clinical manifestations of autonomie neuropathy-

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To make this tension constructive, the ethicist and clinician should share something of each other's language and method while preserving the identity of their own discipline. If teachers of ethics should be at the bedside for the benefit of medical students, students of philosophy should be there also. In a unique program at the University of Tennessee, graduate students of philosophy spend an intensive residency in the hospital, the better to ground their cogitations in the moment of clinical truth.A variety of methods are now being used to ground medical ethics more firmly in the moment of clinical truth-ethical grand rounds, bedside rounds, ethical committees, and prob¬ lem-oriented seminars. To be salubrious for medicine and philosophy, they must avoid the double dangers of overidentification and of alienation of the two disciplines.If these dangers are obviated, the most important outcome will be physicians and ethicists of the future better equipped to assist patients and their families to exert their own moral agency. This would move medicine to a more sophisticated and more mature patient-physician relationship than at any time in its distinguished history.

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