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Consensus Statement on the Triage of Critically III Patients
Society of Critical Care Medicine Ethics Committee;
Charles L. Sprung, MD, JD, FCCM;
Marion Danis, MD;
Mary Ann Baily, PhD;
Donald B. Chalfin, MD;
T. Forcht Dagi, MD;
Fidel Davila, MD;
Michael De Vita, MD;
H. Tristram Engelhardt, Jr, PhD, MD;
Ake Grenvik, MD;
Paul B. Hofmann, MPH;
John W. Hoyt, MD;
W. Andrew Kofke, MD;
Joanne Lynn, MD;
Mary Faith Marshall, PhD;
Rev James J. McCartney, PhD;
Robert M. Nelson, MD;
Nicholas Ninos, MD, US;
Russell C. Raphaely, MD;
Frank Reardon, JD;
Michael A. Rie, MD;
Stanley H. Rosenbaum, MD;
Henry Silverman, MD;
Frank D. Sottile, MD;
Allen Spanier, MD;
Avraham Steinberg, MD;
Rabbi Moses D. Tendier, PhD;
Daniel Teres, MD;
Robert D. Truog, MD;
Thomas E. Wallace, MD, JD;
Ginger Wlody, RN, MS;
Timothy S. Yeh, MD
JAMA. 1994;271(15):1200-1203.
Abstract
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The demand for medical services such as critical care is likely to often exceed supply. In the setting of these constraining conditions, institutions and individual providers of critical care must use some moral framework for distributing the available resources efficiently and equitably. Guidelines are therefore provided for triage of critically ill patients. There are several general principles that should guide decision making: providers should advocate for patients; members of the provider team should collaborate; care must be restricted in an equitable system; decisions to give care should be based on expected benefit; mechanisms for alternative care should be planned; explicit policies should be written; prior public notification is necessary. Patients who are not expected to benefit from intensive care, such as those with imminently fatal illnesses or permanent unconsciousness, should not be placed in the intensive care unit. Hospitals should assign individuals the responsibility of intensive care triage, and a committee should oversee the performance of this responsibility to facilitate the most efficient and equitable use of intensive care.
(JAMA. 1994;271:1200-1203)
Author Affiliations
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Hadassah-The Hebrew University of Jerusalem (Israel); University of North Carolina at Chapel Hill; Associate Justice Christopher Armstrong, The Appeals Court, Commonwealth of Massachusetts, Boston; George Washington University, Washington, DC; Winthrop University Hospital, Mineola, NY; The Kennedy Institute of Georgetown University, Washington, DC; Texas A & M University College of Medicine-Temple Campus; University of Pittsburgh (Pa) School of Medicine; Baylor College of Medicine, Houston, Tex; University of Pittsburgh (Pa) School of Medicine; Stanford (Calif) University Center for Biomedicail Ethics; St Francis Medical Center of Pittsburgh (Pa); Andrew Jameton, PhD, University of Nebraska Medical Center, Omaha; University of Pittsburgh (Pa); Dartmouth-Hitchcock Medical Center, Hanover, NH; Medical University of South Carolina, Charleston; Villanova (Pa) University; Medical College of Wisconsin, Milwaukee; Army Medical Corps (Ret), Palm Springs, Calif; Children's Hospital of Philadelphia (Pa); Hassan and Reardon, Boston, Mass; University of Kentucky College of Medicine, Lexington; Yale University School of Medicine, New Haven, Conn; University of Maryland School of Medicine, Baltimore; St Vincent's Hospital, Worcester, Mass; Jewish General Hospital of Montreal (Quebec); The Hebrew University of Jerusalem (Israel); Yeshiva University, New York, NY; Baystate Medical Center, Springfield, Mass; Harvard Medical School, Boston, Mass; University of Tennessee at Memphis; University of California-Los Angeles School of Nursing; The Children's Hospital of Oakland (Calif).
Footnotes
From the Society of Critical Care Medicine Ethics Committee. A complete list of the members of this committee appears at the end of this article.
No portion of this statement is offered or intended as legal advice for any of the matters discussed. Competent legal counsel should be consulted as appropriate for specific cases involving these issues.
Reprint requests to Society of Critical Care Medicine, 8101 E Kaiser Blvd, Anaheim, CA 92808-2214 (Ms Charm Kohlenberger).
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