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—We thank Dr Whittaker for her thoughtful comments interpreting our study in the framework of the US health care system. There is no direct evidence about differences between United States and Canadian intensivists in decision making about the withholding and withdrawing of life support. In contrast to Whittaker, colleagues in the Canadian Critical Care Trials Group who have worked in both countries have found more similarities than differences in approach. At the same time, there are definite cultural issues that may affect the care that is delivered, including individualist vs socialist perspectives, financial incentives for health care providers, technological access, and the threat of litigation.By design, we focused on the attitudes and beliefs of ICU health care workers, in isolation of patient advance directives, family wishes, ability to pay, or other resource constraints. We agree that consideration of these issues would be important in any research program
Cook D. Withdrawing Life Support in Canada and the United States-Reply. JAMA. 1995;274(5):384. doi:10.1001/jama.1995.03530050032026