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Rationing Intensive Care

Robert Baker, PhD; Martin A. Strosberg, PhD
JAMA. 1994;272(19):1480-1481. doi:10.1001/jama.1994.03520190022013.
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To the Editor.  —We applaud the Society of Critical Care Medicine Ethics Committee1 for developing a consensus statement that forthrightly recognizes medical triage2 as the principle of rationing appropriate to critical care admission and discharge decisions. Although we generally concur with the committee, we note one omission and one inconsistency in their consensus statement.The committee properly asserts that triage decisions "must be made explicitly, fairly, and justly," and that "ethnic origin, race, sex, creed, social worth, and ability to pay should never be factors in determining triage decisions." Conspicuously absent from this list is "chronological age." The absence is conspicuous because Norman Daniels3 and others have been arguing that chronological age in itself (not merely as a prognostic indicator) is a sufficient reason for denying access to advanced medical technology. Failing to list chronological age as discriminatory opens the door to age rationing. We appreciate the


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