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Báo cáo y học: "Can we afford open-ended ICU care? Yes we can, but"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Can we afford open-ended ICU care? Yes we can, but | Arnold et al. Critical Care 2010 14 447 http ccforum.eom content 14 5 447 CRITICAL CARE LETTER L_ Can we afford open-ended ICU care Yes we can but . Klaas-Sierk Arnold Jaap E Tulleken Jack JM Ligtenberg and Jan G Zijlstra See related review by Crippen etal. http ccforum.Com content 14 3 222 The question whether we can afford open-ended intensive care unit ICU care should be answered with yes we can but . 1 . The discussion is polarized. The US system will crash because everybody is right when it comes to open-ended care and in Europe endless care is prohibited or rationed. With polarization we lose sight of the middle path where truth and solutions usually are found. The rationale that it is better to treat 10 non-survivors than not to treat one possible survivor is erroneous. We are not freeing patients destined to die but are condemning them to suffer in the ICU for an indeterminate length of time. For each survivor many others are harmed. Nobody knows the right balance and questionable choices are unavoidable. It is our responsibility to make those decisions together with the patient and family. We now admit many patients who have a bad prognosis. The number of patients dying in the ICU is increasing 2 . Admitting patients who have a 1-year survival of 30 causes harm to 70 3 . We should educate the public that life and ICU care are not commodities. ICU care has limitations and without exception causes harm. We should teach our colleagues that there is no safe side and that we have to have the courage to make decisions. We should also improve end-of-life care. If imminent death is inevitable we should do our utmost to give the patient a good death 4 . Open-ended care for everybody causes harm to too many and is not affordable. With courage and education we might avoid both harm and exorbitant cost and be able to provide intensive care for the patients who need it. Author s response David Crippen Educating the American public as to the right thing to do in .