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February 1983

Pediatric Critical Care: Should Medical Costs Influence Clinical Decisions?

Author Affiliations

From the Departments of Pediatric Cardiology—Pediatric Intensive Care (Dr Griffin) and Medical Humanities (Dr Thomasma), Loyola University Stritch School of Medicine, Maywood, Ill.

Arch Intern Med. 1983;143(2):325-327. doi:10.1001/archinte.1983.00350020151027

In an era of rising health care costs, serious questions have been raised about the allocation of scarce medical resources and about the role of physicians in such decisions. The literature reflects considerable and, at times, acrimonious disagreement about these issues.1,2 This article examines the allocation dilemma, with respect to pediatric critical care, and focuses on two central questions.

The first question is how broad theories of social justice should be applied to the discipline of pediatric critical care, ie, how should the sometimes extraordinary costs of such care be taken into account when society allocates its (health care) resources? The second problem is reconciling the physician's potentially conflicting roles as gatekeeper of medical resources with a personal physician's intent to do everything necessary to treat a patient. These questions are explored by reporting a case in which physicians debated whether to treat a patient or whether to withhold

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