To the Editor.
—I read with interest the article by Dr Cook and colleagues1 describing factors that influence Canadian health care workers in their decision to withdraw life support from critically ill patients. There are innumerable medical and ethical considerations involved in end-of-life decisions. The authors effectively illustrate that several factors unrelated to patient characteristics influence Canadian health care workers in their decisions, leading to "extreme variability" in how these situations are handled in Canada. The situation is a little different in the United States, however, and the authors do not allude to the differences in making end-of-life decisions that exist between the two countries. An important influence on who actually makes the decision is the allocation of health care resources. Canada has a nationalized system of health care in which limited resources (including intensive care unit [ICU] beds and life support equipment) are allocated on the basis of
Whittaker LA. Withdrawing Life Support in Canada and the United States. JAMA. 1995;274(5):384. doi:10.1001/jama.1995.03530050032025