In Reply. —
We appreciate Cohn's comments on our recent editorial.1 We share his concern that the overuse of life-sustaining technologies in this country will continue to escalate. The increasing demand for intensive care is encouraged by patient expectations, clinician inclinations, and societal ambivalence toward the explicit rationing of care. This problem cannot be solved at the individual patient-physician level of decision making. There is little reason to believe that patients facing critical illnesses will suddenly elect not to use the best intensive care available, or that physicians will resist using the technologies that are so readily accessible. The issues that must be deliberated in finding a solution to the imbalance between supply and demand for intensive care will require a national forum, such as the "health care summit" that we proposed. However, in the meantime, we are not advocating a
Bone RC, Elpern E. The Intensive Care Unit—Industrial Complex-Reply. Arch Intern Med. 1992;152(2):417–421. doi:10.1001/archinte.1992.00400140151037
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