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March 7, 1986

Intensive Care Units, Scarce Resources, and Conflicting Principles of Justice

Author Affiliations

From the Center for Ethics, Medicine, and Public Issues, Baylor College of Medicine, Houston (Dr Engelhardt); and the Respiratory/Surgical Intensive Care Unit and Anesthesia and Medical Services of the Massachusetts General Hospital, Boston (Dr Rie).

JAMA. 1986;255(9):1159-1164. doi:10.1001/jama.1986.03370090081025

HUMANS often have the aspirations of deities, though never the resources. Intensive care units (ICUs) provide an example of the desire to provide an optimal level of care for all who require it, where "optimal" is taken to mean the highest achievable standard of care. However, recent budgetary retrenchments in the provision of funds for health care show that health care is not always an overriding public policy priority. Consequently, as a matter of morality and public policy, it will be necessary to determine at what point undesirable standards of health care are simply unfortunate, but not unfair in the sense of constituting a claim on further resources.

We explore the distribution of health care resources by addressing the problem of allocating ICU beds (1) when further admissions to an ICU will jeopardize the standard of health care for all those in the ICU, (2) when those eligible for admission