World of Intensive Care Units:
Secular and Reform Jewish
Reflections on the Roman
Michael A. Rie
In this volume, Roman Catholic scholars attempt to synthesize those features of Catholic theology that might impart a distinct vision of resource allocation in critical care settings. In the twentieth century, critical care medicine and intensive care units were the site of significant technological and medical progress. Economic resource allocation and consumption issues developed in parallel with such short- and long-term prognostic possibilities for the prolongation of life. For example, as early as 1957 Pope Pius XII was asked to explicate a Catholic moral position regarding the use of critical care technology for individuals with severe brain injuries. Secular ethics has also struggled with these and similar problems. Indeed, physicians generally have been confronted with such questions for some time (see, e.g., LeMaire 1996; Lanken, Terry, and Osborne 1997; Osborne and Patterson 1996; Society of Critical Care Medicine Ethics Committee 1997).
The authors of this volume have come to a general consensus regarding the implications of Roman Catholic moral theology for the allocation of critical care resources. As a non-Christian, non-Roman Catholic, it appears to me that Catholics hold “respect for human life” to be a central principle. Jews hold a similar principle and share a common heritage. Whereas Catholic theology appears to support the view that all human life is sacred, it is said in Jewish circles that one who saves a life saves a people. Such principles come under serious challenge, however, in intensive care units (ICUs), where accepting the sacredness of all human life as an absolute principle may lead, contradictorily, to the loss of salvageable human life through less than optimal care for all. Attempting to provide the very best of care for all, without any honest assessment of resource rationing, leads to serious, yet often unacknowledged, scarcity and the loss of salvageable patients. This circumstance underlies my reflections in this chapter.