title: The ethics of rationing of critical care services: should technology assessment play a role?
abstract: The costs of health care continue to increase rapidly and steeply in the United States. One area of great expense is that of intensive care units (ICUs). The causes of inflation have not been addressed effectively. ICU resources could become stretched such that they may no longer be available. This paper discusses some of the ethics and concerns behind decision making when providing ICU services in the United States. In particular, the use of electronic records with decision making tools, risk-analysis methods, and documentation of patient wishes for extraordinary care may help with better utilization of resources in the future.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Bloomfield
references.citation: Health Aff (Millwood). 1994 Summer;13(3):70-9
references.pmid: 7726901
references.citation: Crit Care Med. 1993 Nov;21(11):1777-80
references.pmid: 8222697
references.citation: Crit Care Med. 1995 Apr;23(4):760-6
references.pmid: 7712768
references.citation: Crit Care Med. 1995 Oct;23(10):1745-55
references.pmid: 7587242
references.citation: Am J Bioeth. 2001 Spring;1(2):28
references.pmid: 11951878
references.citation: Cost Qual. 1999 Dec;5(4):14-26
references.pmid: 11066611
references.citation: Crit Care Med. 1995 Oct;23(10):1756-63
references.pmid: 7587243
references.citation: Crit Care Med. 1994 Feb;22(2):358-62
references.pmid: 8306698
references.citation: Arch Surg. 2002 Jan;137(1):37-41
references.pmid: 11772212
references.citation: Crit Care Med. 1999 Feb;27(2):270-4
references.pmid: 10075049
references.citation: J Crit Care. 2003 Mar;18(1):38-40
references.pmid: 12640612
references.citation: Anesth Analg. 2003 Feb;96(2):311-4
references.pmid: 12538169
references.citation: J Crit Care. 2003 Mar;18(1):59-67
references.pmid: 12640616
references.citation: New Horiz. 1994 Aug;2(3):392-403
references.pmid: 8087602
references.citation: N Engl J Med. 2009 Apr 16;360(16):1628-38
references.pmid: 19321858
references.citation: Circulation. 2009 Jan 6;119(1):147-52
references.pmid: 19124674
references.citation: Demography. 1997 Feb;34(1):49-66
references.pmid: 9074831
references.citation: N Engl J Med. 2003 Jun 19;348(25):2526-34
references.pmid: 12815139
references.citation: Chest. 1995 Aug;108(2):490-9
references.pmid: 7634889
references.citation: Circulation. 2003 Aug 26;108(8):915-8
references.pmid: 12939241
references.citation: JAMA. 1991 Oct 16;266(15):2135-41
references.pmid: 1920704
references.citation: Int J Technol Assess Health Care. 1992 Summer;8(3):395-407
references.pmid: 1399326
references.citation: CMAJ. 2001 May 29;164(11):1583-7
references.pmid: 11402800
references.citation: Med Care. 1985 Dec;23(12):1345-57
references.pmid: 4087950
references.citation: Anesth Analg. 2003 Feb;96(2):418-25
references.pmid: 12538189
references.citation: Chest. 1999 Oct;116(4):1092-9
references.pmid: 10531177
references.citation: Crit Care Med. 1990 Nov;18(11):1282-6
references.pmid: 2225900
references.citation: Int J Technol Assess Health Care. 1992 Summer;8(3):408-18
references.pmid: 1399327
references.citation: Am J Respir Crit Care Med. 2002 Mar 15;165(6):750-4
references.pmid: 11897638
references.citation: N Engl J Med. 2008 Dec 11;359(24):2517-9
references.pmid: 19073974
references.citation: Crit Care. 1999;3(1):R1-R3
references.pmid: 11094475
references.citation: N Engl J Med. 2002 Mar 21;346(12):877-83
references.pmid: 11907286
references.citation: Crit Care Med. 1992 Jul;20(7):928-33
references.pmid: 1617985
references.citation: N Engl J Med. 2005 Oct 6;353(14):1471-80
references.pmid: 16207849