Ration or rescue: the elderly patient in critical care

1. Persons who require the intensive interventions of critical care units enter with a contract of trust. They place their well-being, and often their lives in the hand of caregivers. To respect that trust by the most vigorous effort is a moral responsibility. 2. It is not the task of the practitioner in critical care to evaluate the social worth of the patient. Judgments as to the quality of life of individual patients are inappropriate and unsupportable and should never be used as a rationale for withholding or withdrawing essential care. 3. The decisions for introducing treatments should be based (as they have been historically) on the physician's evaluation of the patient's condition and the consequent appropriate interventions. The interference of third party payers in this clinical relation in which therapeutic decisions are dictated by cost or any other extraneous factors is morally repugnant. 4. Life or death decisions are not properly those of caregivers and should never be left to those whose mission is to protect life and relieve suffering. Decisions to use extraordinary means of sustaining life processes should be made in advance of the actual events by the informed wisdom of the physician whenever possible. The caregivers--physicians and nurses-should bring all their skills to bear to alleviate suffering, but that does not include hastening the death of another human being.