Author Affiliation: London School of Intensive Care Medicine, London, England.
In a recent article, Stelfox et al1 make an important observation that when less intensive care unit (ICU) beds are available, the decisions to change patients' goals of care to a more conservative approach increases. This appears to be a response to the lack of ICU facilities rather than an active decision. When it is deemed unlikely to avert death, and death is imminent, our duty to provide patients with supportive care is no less important than our duty to save lives. Advance care planning and any decision to palliate should not be viewed as an option arising from the lack of resources. This requires adequate recognition and training.
Arulkumaran N. Advance Care Planning of the Acutely Unwell Patient. Arch Intern Med. 2012;172(16):1268-1269. doi:10.1001/archinternmed.2012.2518