—We are grateful to Drs Shapiro and Muskin for pointing out that we did not discuss cognitive impairment or psychiatric disorders. We agree that some harmful decisions originate in emotional disturbances and pathological thought processes. Statistics on suicide rates, for example, poignantly document the consequences of depression. However, readers should not conclude that problems in judgment and decision making are confined to patients with neurological or psychiatric disorders. Our aim in the article was to emphasize that normal human intuitions are prone to predictable errors. Clinicians should be alert to the harmful mistakes that reasonable patients are likely to make in evaluating risks and benefits.