Distributive Justice Across Generations: Epidemiology of ICU Care for the Very Young and the Very Old
Lantos, John D.
Clinics in Perinatology. 1996 Sep; 23(3): 597-608.
Babies of extremely low birthweight and elderly adults both require expensive and scarce resources, and both have a relatively poor prognosis for survival if they require intensive care. Thus, proposals for rationing often target one or both of these groups. We suspected that although mortality rates might be higher in the neonatal intensive care unit (NICU) than in the adult intensive care unit (ICU), NICU care might nevertheless be more cost effective, where cost efficiency is measured along the dimension of resources targeted to survivors. We examined mortality patterns in our NICU and for adults admitted to our medical intensive care units. We found that adult ICU patients who died consumed many times more ICU resources before their death than did their NICU confreres, independent of the severity of illness or likelihood of dying. Although there may be many legitimate concerns about justice and ethics in the NICU, undue expenditure of society's resources prolonging the dying of extremely low birthweight infants is not among them. To the extent that concerns about distributive justice drive allocation decisions in ICU care, it would seem more justifiable to ration intensive care for the very old, not the very young.
Adults; Age Factors; Aged; Biomedical Technologies; Comparative Studies; Death; Economics; Epidemiology; Ethics; Infants; Intensive Care Units; Illness; Justice; Medical Records; Minors; Mortality; Newborns; Patient Care; Patients; Prognosis; Records; Resource Allocation; Selection for Treatment; Treatment Outcome;
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Distributive Justice Across Generations: Epidemiology of ICU Care for the Very Young and the Very Old Meadow, William; Lantos, John D.; Mokalla, Mani; Reimshisel, Tyler (1996-09)
Birth Weight-Specific Mortality for Extremely Low Birth Weight Infants Vanishes by Four Days of Life: Epidemiology and Ethics in the Neonatal Intensive Care Unit Meadow, William; Reimshisel, Tyler; Lantos, John (1996-05)BACKGROUND. The persistent differences between those who question the appropriateness of aggressive resuscitative measures for many extremely low birth weight (ELBW) infants (birth weight less than 1001 g) and those ...
Birth Weight-Specific Mortality for Extremely Low Birth Weight Infants Vanishes by Four Days of Life: Epidemiology and Ethics in the Neonatal Intensive Care Unit Meadow, William; Reimshisel, Tyler; Lantos, John (1996-05)