This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Paul E. Kalb, MD; David H. Miller, MD

JAMA. 1989;261(16):2389-2395.

Abstract
Critical care resources in the United States are being rationed, that is, not all critical care expected to be beneficial is being provided to all patients who desire it. Although the extent of rationing is uncertain, it is an everyday occurrence in some hospitals and is likely to occur at least some of the time in many hospitals. Substantial evidence suggests that current rationing practices are highly subjective and perhaps inequitable. Critical care is widely believed to be beneficial to many patients, despite a striking dearth of supportive data. Since this type of care is being inequitably denied to some patients, hospitals should either adopt formal rationing guidelines or, alternatively, they should take clear steps to avoid rationing by altering the supply of or the demand for critical care. Reasonable arguments are presented in support of both approaches, as are suggestions for their implementation.

(JAMA. 1989;261:2389-2395)

Author Affiliations
From the Yale Law School, New Haven, Conn (Dr Kalb), and the Department of Medicine, Division of Cardiology, the New York Hospital—Cornell Medical Center, New York, NY (Dr Miller).

Footnotes
Reprint requests to Division of Cardiology, the New York Hospital—Cornell Medical Center, 525 E 68th St, Starr-4, New York, NY 10021 (Dr Miller).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Lifeboat Ethics: Considerations in the Discharge of Inpatients for the Creation of Hospital Surge Capacity
Kraus et al.
dmphp 2007;1:51-56.
FULL TEXT  

Improving the ICU: Part 1
Garland
Chest 2005;127:2151-2164.
ABSTRACT | FULL TEXT  

Acute and chronic paediatric intensive care patients: current trends and perspectives on resource utilization
Briassoulis et al.
QJM 2004;97:507-518.
ABSTRACT | FULL TEXT  

Admission and Discharge Guidelines for the Pediatric Patient Requiring Intermediate Care
Jaimovich and Committee on Hospital Care, and Section on Critica
Pediatrics 2004;113:1430-1433.
ABSTRACT | FULL TEXT  

Outcomes of and Resource Consumption by High-Cost Patients in the Intensive Care Unit
Welton et al.
Am J Crit Care 2002;11:467-473.
ABSTRACT | FULL TEXT  

A Multicenter Description of Intermediate-Care Patients* : Comparison With ICU Low-Risk Monitor Patients
Junker et al.
Chest 2002;121:1253-1261.
ABSTRACT | FULL TEXT  

Outreach Education to Improve Quality of Rural ICU Care . Results of a Randomized Trial
HENDRYX et al.
Am. J. Respir. Crit. Care Med. 1998;158:418-423.
ABSTRACT | FULL TEXT  

Use of Intensive Care Units for Patients With Low Severity of Illness
Rosenthal et al.
Arch Intern Med 1998;158:1144-1151.
ABSTRACT | FULL TEXT  

Fair Allocation of Intensive Care Unit Resources
Am. J. Respir. Crit. Care Med. 1997;156:1282-1301.
FULL TEXT  

Ethical Considerations in the Allocation of Organs and Other Scarce Medical Resources Among Patients
Council on Ethical and Judicial Affairs, American et al.
Arch Intern Med 1995;155:29-40.
ABSTRACT  

Consensus Statement on the Triage of Critically III Patients
Society of Critical Care Medicine Ethics Committee et al.
JAMA 1994;271:1200-1203.
ABSTRACT  

Rationing and the Americans With Disabilities Act
Orentlicher
JAMA 1994;271:308-314.
ABSTRACT  

Analysis of Power in Medical Decision-Making: An Argument for Physician Autonomy
Koch et al.
J Law Med Ethics 1992;20:320-326.
 

One Year's Experience With a Noninvasively Monitored Intermediate Care Unit for Pulmonary Patients
Krieger et al.
JAMA 1990;264:1143-1146.
ABSTRACT  

Early "Step-Down" Transfer of Low-Risk Patients with Chest Pain: A Controlled Interventional Trial
Weingarten et al.
ANN INTERN MED 1990;113:283-289.
ABSTRACT  

Ethical Principles in Critical Care
Luce
JAMA 1990;263:696-700.
ABSTRACT  

Utilization Strategies for Intensive Care Units
Franklin
JAMA 1989;262:1467-1468.
ABSTRACT