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November 16, 1994

Rationing Intensive Care-Reply

Author Affiliations

Society of Critical Care Medicine Anaheim, Calif

JAMA. 1994;272(19):1481-1482. doi:10.1001/jama.1994.03520190022015

In Reply.  —We believe it is not necessarily discriminatory to consider age as a contributing factor in ICU triage for several reasons. First, if one takes an "over-the-life-span" perspective, the young and the old are at different time points in a common life experience and should develop a shared perspective about the best care for individuals at different times in the life cycle. From this shared perspective, the most appropriate medical care may vary with age. Second, even if one does not agree with this ethical view, empirical evidence shows that chronological age is a determinant of prognosis for critically ill patients.2 Third, if one takes a cost-benefit perspective, even when a young individual and an old individual have the same diagnosis, severity of illness, functional status, and probability of ICU survival, statistically the younger individual will likely have a longer period of benefit than the older individual. On

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