Commentary On the allocation of critical care resources

Abstract

0 AREA of medicine has escaped the rising tide of ethical concerns wrought by our present health care system, particularly those brought about by an increasing commitment on the part of many health care providers to some form of health care rationing. This fact is certainly true for critical care medicine. The very nature of critical care, however, makes it inordinately difficult to objectively address any idea of rationing health care resources. To begin with, the idea of restricting such resources is prima facie antithetical to our understanding of the philosophy and moral principles that undergird the discipline. In addition, the public’s expectations are tied to the traditional Hippocratic patient-centered model of commitment on the part of the clinician, a commitment that has no room for withholding any beneficial resources from a patient in need. Nonetheless, recognition of the ethical dilemmas created by the national belief that health care rationing is inevitable, and their impact on the care of patients and the ethics of the physician-patient relationship are matters of wide public concern. Among these concerns are many serious questions pertaining to rationing of critical care resources that need to be examined at some depth. For example, how can critical care practitioners be equipped to practice moral medicine when they are besieged to practice cost-efficient and profitable medicine? How can the moral dimension of medicine be preserved in a cost-conscious and cost-driven environment? These are not easy questions to respond to in a time of unparalleled structural and economic uncertainty in the delivery of health care.