Economic and ethical consideration in the intensive care unit

Intensive care units (ICUs) sustain life but, in certain cases, this resource becomes a means to prolong dying, with great physical, emotional and financial impact. The cost to care for patients in the ICU is at least three times more than general ward care; thus, ICUs have become one of the largest cost centres in the hospital. Economic pressures require us to be mindful of whom the ICU treats and for how long. Health professionals working in the ICU must critically appraise the ethical basis for their behaviour and actions. In so doing, many are likely to appeal to the patient's right to self-determination and the physician's reliance on the principles of beneficence and non-maleficence as the underpinnings of morality in medicine. One approach is to examine the issues and rights pertinent to an individual case using a circular model. Decisions are based on medical facts and prognosis, a patient's right to self-determination, a patient's best interests and external factors. Health personnel would be compelled to consider all of these issues. Within this framework, prevention or resolution of moral dilemma can take place within the clinical rather than the legal forum.