Proposals have been developed to clarify physician responsibility in withholding treatment to terminally ill patients. These proposals seek to provide a legal shield against malpractice proceedings and to reduce confusion over how to resolve high medical costs through standardizing procedures for withholding treatment. When first published, withholding treatment guidelines pertained only to patients whose deaths were expected within weeks. The new proposals include hopelessly ill patients, those patients who are irreversibly ill but not clearly dying. Five categories of hopelessly ill patients are: (1) competent patients who refuse treatment; (2) brain-dead patients; (3) persons in persistent vegetative states; (4) severely and irreversably demented persons; and (5) persons with mild dementias who should be treated "sparingly." While the first three categories break no new medical ground, conditions 4 and 5 appear to be outside the scope of approved medical standards of care and several major criticisms of the proposals can be made. Two major questions which should be considered in any public debate over treatment policies to sick elderly persons are the determination of competence in the sick elderly and, where incompetence is present, what is to be the role of families. Perhaps the most important contribution that gerontologists can make to this debate involves insisting on guidelines that enable the sick elderly to control their own futures if they choose to do so. (NB)