Task Force to Address Medical Rationing in ICUs

A special task force has been formed to investigate medical rationing in US intensive care units (ICUs) and develop guidelines that will help clinicians make decisions that distribute healthcare resources equitably and appropriately. Called the VERICC (Values, Ethics & Rationing in Critical Care) Task Force, the group includes experts in bioethics, critical care, evidence-based medicine, technology assessment, and healthcare administration from such institutions as Harvard Medical School and the US National Institutes of Health.

Medial rationing is on the rise in US hospitals. In a 2002 survey by the Society of Critical Care Medicine, nearly two-thirds of critical care providers reported that they would withhold a medication, test, or service in limited supply in order to give it to another patient who might benefit more. In addition, more than half of these providers reported routinely withholding medications, tests, or services from patients when they thought the cost outweighed potential benefit.

The task force will examine the factors that contribute to rationing practices. Using the resulting data, the group plans to develop practical models and guidelines designed to help clinicians make fair and appropriate treatment decisions when dealing with a limited resource. The group also plans to create a comprehensive database and software capable of assisting ICU personnel in making resource allocation, no matter where they are located.

Instead of asking if medical rationing is taking place, there is a need to ask how best to ration what there is, according to Mitchell Levy, M.D., of Brown Medical School/ Rhode Island Hospital (Providence, RI, USA; www.brownmedicine.org) and founder of the VERICC Task Force. "Without practical and ethical resource allocation guidelines in place, the current patchwork of ICU rationing practices will continue to proliferate without rhyme or reason, unnecessarily jeopardizing the health of patients most in need of care.”




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