While authors Franklin M. Zweig and Seymour Perry {Second Opinion, July 17} refer only to one type of judgment -- orders by judges that insurers cover the cost of marrow transplants for cancer patients -- their discussion raises the broader issue of what role, if any, the courts should have in making other types of medical decisions.

Zweig and Perry state that "the courts increasingly will be called upon to make life-and-death decisions." However, it seems that by asking the courts to act at any difficult turn of events, critical health decisions are taken out of the hands of those most qualified: the patient and family, in consultation with medical professionals and others, perhaps clergy, who may contribute to the dialogue.

We have seen the outcome of state interference in the Nancy Cruzan case, where no one doubted the good-faith intent of family members who were certain that she had really died long ago. With or without Nancy Cruzan's clear and convincing statements as required by the Supreme Court's decision, the request by the family to stop food and hydration was rational and loving. For the state to intervene, as if it could better protect Cruzan's interests, became an example of judicial meddling of the worst sort.

What the Cruzan case has shown us is that we are rapidly approaching a time when providers -- primarily physicians and sometimes hospitals -- must begin to see their roles much more broadly than just healers and care givers. If we are to be allowed to decide our own fates without court interference, physicians will need to strengthen their role as the primary source of health information for their patients, and not simply give them information about the hazards of smoking and a high-cholesterol diet.

For their own sake and for the sake of their patients, physicians will need to take on the responsibility of advising patients and family members about advance directives, living wills and treatment options. And, rather than waiting until the patient is no longer competent and the courts may have to intervene, they will need to begin this process at the start of the doctor-patient relationship.

Each physician, no matter how specialized his or her training, will have to become a more holistic healer, attentive not only to the specific body part in question but to the total quality of life.

That means that the cardiologist will no longer simply assess the condition of the heart but must begin to talk with the patient to understand the mind and soul that are attached. The oncologist's goal will not be limited to ridding the body of a tumor but will be extended to learning from the patient what radiation, chemotherapy or other treatments will do to the whole person. Without such expanded roles, we will be doomed to the courts for our final judgments.

Patients share these expanded responsibilities. It is emotionally difficult to discuss becoming old, debilitated or disabled, but, as technology continues to advance, patients can avoid this conversation no longer.

The choices resemble the television ad with the automobile repairman: "You can pay me now or pay me later." We can choose to address these issues with our physicians and our families now, or let the courts decide them for us later.

The examples cited by Zweig and Perry of courts ordering insurers to pay for experimental treatments also rely inappropriately on the judiciary. In these cases, moving the decisions from the health care to the judicial arena takes away any hope of utilizing medical expertise effectively.

The decisions then become a public relations circus, without a shred of grounding in reason. As research advances, patients must ask for clearer pictures of their own prognoses, and physicians must be more honest with themselves about identifying the differences between realistic expectations and false hopes. Without such medical integrity, we force the courts to be our surrogates.

This is not to say that the courts have no role at all. Clearly, when family members or medical professionals attempt to make treatment decisions with gross disregard for the patient, the patient's rights must be protected. It is for these cases that Zweig and Perry's plea for impartial medical expertise is fitting. However, increasing reliance on judges -- who must look outside their own areas of expertise for guidance in making life-and-death decisions -- will not ultimately serve the best interests of patients.

In an era of limited health care dollars, it is incumbent upon health care professionals, individual patients and their families to make more informed analyses of what is reasonable to expect. There is a limit on the length of life; no matter how advanced medical technology becomes, it is finite. Thus, as a community, we must develop our values about what makes an acceptable quality of life for each of us, and how much we are willing to spend to obtain it.

We cannot escape these questions. We do, however, have the power to answer them for ourselves.

In a recent article in the New England Journal of Medicine, ethicist Daniel Callahan of the Hastings Center states that once we realize that there are not unlimited dollars for health care, it is important to search for "a means of limiting the use of procedures that are ineffective or marginally effective as well as some of the procedures that are effective but too expensive."

The means cannot be the courts, but ourselves, with the advice of the medical and spiritual professionals who serve us.

Joan H. Lewis is vice president of the District of Columbia Hospital Association.