Ethics and Critical Care Medicine

1. Front Matter

   Pages i-xx

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2. A Movable Medical Crisis

   • Warren Thomas Reich

   Pages 1-10

3. Moral Absurdities in Critical Care Medicine: Commentary on a Parable

   • Warren Thomas Reich

   Pages 11-21

4. Moral Tensions in Critical Care Medicine: “Absurdities” as Indications of Finitude

   • H. Tristram Engelhardt Jr.

   Pages 23-33

5. “Conceptual Construals” vs. Moral Experience: A Rejoinder

   • Warren Thomas Reich

   Pages 35-40

6. Can Principles Survive in Situations of Critical Care?

   • Jay Katz

   Pages 41-67

7. Coercion, Conversation, and the Casuist: A Reply to Jay Katz

   • Stuart F. Spicker

   Pages 69-77

8. Justice and the Hippocratic Tradition of Acting for the Good of the Sick

   • Loretta Kopelman

   Pages 79-103

9. Clinical Ethics and Resource Allocation: The Problem of Chronic Illness in Childhood

   • James M. Perrin

   Pages 105-116

10. Moral Choice, the Good of the Patient, and the Patient’s Good

    • Edmund D. Pellegrino

    Pages 117-138

11. What Good is Another Paper on the Good? No Codes and Dr. Pellegrino

    • Sally A. Gadow

    Pages 139-145

12. Allocating Resources within Health Care: Critical Care vs. Prevention

    • John C. Moskop

    Pages 147-161

13. Report of the President’s 2003 Commission on the Fall of Medicine

    • Gregory E. Pence

    Pages 163-170

14. Triage and Critical Care

    • Joseph Margolis

    Pages 171-189

15. The Ethics of Critical Care in Cross-Cultural Perspective

    • Robert M. Veatch

    Pages 191-206

16. Triage: Philosophical and Cross-Cultural Perspectives

    • Ross Kessel

    Pages 207-214

17. Critical Care in an Historical Context

    • Stanley J. Reiser

    Pages 215-224

18. Commentary on Stanley J. Reiser’s ‘Critical Care in an Historical Context’

    • Peter C. English

    Pages 225-230

19. Back Matter

    Pages 231-236

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The expense of critical care and emergency medicine, along with widespread expectations for good care when the need arises, pose hard moral and political problems. How should we spend our tax d'ollars, and who should get help? The purpose of this volume is to reflect upon our choices. The authors whose papers appear herein identify major difficulties and offer various solutions to them. Four topics are discussed throughout the volume: First, encounters between patients and health professionals in critical situations in general, and where scarcity makes rationing necessary; second, allocation and social policy, including how much to spend on preventive, chronic or critical care medicine, or for medicine in general compared to other important social projects; third, conflicts between or ranking of important goals and values; and fourth, conceptual issues affecting the choices we make. Since these topics are raised by the authors in almost every essay, we did not divide the papers into separate sections within the volume. Warren Reich begins the volume with a parable illustrating a key problem for contemporary medicine and two very different approaches to its solution. His story begins with the "delivery" of three indigent, critically ill, foreign patients to the emergency room of a large American private hospital. Although the hospital is legally bound to care for these patients, providing long term, high cost care for them and others soon becomes a major financial strain.

• clinical ethics
• ethics
• health
• intensive care medicine
• morality

• East Carolina University School of Medicine, Greenville, USA

  John C. Moskop, Loretta Kopelman

Policies and ethics