Implications for Distributive Justice
Kevin W. Wildes, S.J.
Intensive care medicine is, in many ways, an icon of contemporary Western, scientific medicine. In the last half of the twentieth century, modern medicine was transformed in its self-understanding and public perception. Unlike medicine of the past, contemporary medicine defines itself, and is defined by the curative goal. Western societies have come to expect that medicine will cure diseases and illnesses. And, in both the popular and professional imaginations, medical cures are linked with sophisticated technological interventions. Intensive care medicine embodies both the hope for cure in the face of life-threatening sickness and the use of sophisticated technological intervention to achieve the cure. They are the place of many modern medical miracles.
These expectations, of cure with the aid of medical technology, embodied in the intensive care unit (ICU), carry a dark side, however. When facing death, medicine has no cure to offer. Death is a defeat for medicine in a model of curative medicine. When death looms, the temptation is to bring to bear medical technology, even when cure is impossible or there is no hope of any meaningful recovery. In this way, defeat is put off. But such interventions are costly. They consume resources and other opportunities and can exact a human cost from those patients and families directly involved.
The allocation of resources for intensive care medicine poses an important set of ethical questions. How these questions are answered will have a very direct impact on those who might benefit from such medical interventions. Furthermore, the answers to these questions are important because intensive care medicine can easily consume a great deal of a society's medical resources and has implications for the development and distribution of other goods. Developing ethical policy for allocating these resources is important because it has a very direct impact on the lives of patients and on the practice of health care in general.
One way to approach the question about allocating ICU resources is to consider how to develop criteria that establish limits on what amount of resources can and cannot be distributed to patients. On the local level, the question needs to be asked: How should ICU resources be distributed? One finds this approach embodied in the attempts to develop futility policies. Such policies attempt to articulate principles that govern the use and distribution of our resources.