ICU resource allocation: life in the fast lane

Introduction: what\u27s the speed limit? In 1973, the then United States President, Jimmy Carter, addressed the issue of declining petroleum resources and increasing automobile traffic by the institution of a rationing plan that mandated decreasing consumption fairly and equitably across the entire population of consumers. The national speed limit (NSL) decreased from 70 to 55 miles per hour, and, according to experts, constituted the perfect rationing plan [1]. It affected only those who used a scarce resource (gasoline) and it applied to all equally. In a perfect world, it should have been an extremely effective conservation method. However, many motorists in the USA were not eager to participate in this utopian plan designed to rescue the whole. American motorists traditionally drive at a speed that is comfortable for them, considering the surrounding circumstances regardless of a posted limit. The Federal Government assigning a speed that did not feel comfortable to the average motorist virtually guaranteed eventual noncompliance [2]. This otherwise fair rationing plan set the stage for a roadway game of evasion, detection, and escalating technology supporting both sides [3]. The law was eventually repealed because it could not be enforced [4]. As a practical matter, motorists who would comply with the law would not exceed 55 miles per hour regardless of the NSL. Motorists who, for whatever reason choose to exceed the speed limits, will always try to stack the deck in their favor when dealing with speed limit enforcement. As technology for detecting speeders improved, so did the technology for detecting detectors [5]. And so a fair and equitable rationing plan designed to benefit the whole at the cost of minimal individual conformation failed because the administrative cost of enforcing individual compliance effaced the advantage [6]

Ethics review: Dark angels – the problem of death in intensive care

Critical care medicine has expanded the envelope of debilitating disease through the application of an aggressive and invasive care plan, part of which is designed to identify and reverse organ dysfunction before it proceeds to organ failure. For a select patient population, this care plan has been remarkably successful. But because patient selection is very broad, critical care sometimes yields amalgams of life in death: the state of being unable to participate in human life, unable to die, at least in the traditional sense. This work examines the emerging paradox of somatic versus brain death and why it matters to medical science

Pro/con ethics debate: When is dead really dead?

Contemporary intensive care unit (ICU) medicine has complicated the issue of what constitutes death in a life support environment. Not only is the distinction between sapient life and prolongation of vital signs blurred but the concept of death itself has been made more complex. The demand for organs to facilitate transplantation promotes a strong incentive to define clinical death in a manner that most effectively supplies that demand. We consider the problem of defining death in the ICU as a function of viable organ availability for transplantatio