Visualize for a moment the philosophical quandary of a tree falling in the uninhabited forest and whether it makes a sound—the dying tree, its surroundings of fellow trees, foliage, and earth—with no person to hear its fall. This visualization hardly seems relevant to the intensive care unit (ICU), particularly because these seem to be manifestly opposing environments—one is quiet, organic, and verdant with life while the other is characterized by the sounds of human and technological activity, sterility, and illness. And yet the quandary posed by this visual exercise is central to the article by Ernecoff and colleagues¹ and to the question of the role of spirituality in caring for seriously ill patients and their families.

Note: this comment was featured on the APC Best Papers of 2015 bibliography.