Current and emerging legal issues in critical care

Antitrust, access to care, and accountability are but three areas of law directly affecting the provision of critical care services. As the country continues to wrestle with increased health care costs, the expanding needs posed by an aging population and problems such as the AIDS epidemic, and whether or not to adopt some form of national health insurance, the legal system will continue to interact with the health care delivery system. Providers of critical care services are in the forefront of advances in medicine and are in the middle of the political, economic, and policy debates about the shaping of the health care system. They must not allow themselves to be caught at the end of rapid changes in the legal system. Critical care providers must take a leadership role in helping shape the forces that will be the major legal issues in years to come. If providers do not like lawyers and bureaucrats telling them how to provide patient care, they must seize the initiative in shaping defined standards of care. If providers do not like to be forced into providing "useless" or "unnecessary" care, they must be more honest in discussing care options with patients, families, and the media. If they do not like being told for how long to hospitalize a patient, they must be more responsible in making decisions to admit, transfer, or discharge a patient. Lawyers have been quite happy to step into what has long been perceived as a vacuum of leadership among medical care providers, and will continue to do so as long as there is uncertainty and lack of consensus about what constitutes appropriate medical care.