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AMA J Ethics. 2017 Feb 1;19(2):157-163. doi: 10.1001/journalofethics.2017.19.2.ecas3-1702.

What to Do When There Aren't Enough Beds in the PICU.

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Assistant professor of neurology, neurotherapeutics, and neurosurgery at the University of Texas (UT) Southwestern Medical Center in Dallas, and a neurointensivist, and a chair of the UT Southwestern University Hospitals ethics committee and the ethics section of the Neurocritical Care Society, and vice chair of the ethics section of the American Academy of Neurology.
Frances Glessner Lee Professor of Medical Ethics, Anaesthesia, & Pediatrics at Harvard Medical School in Boston, where he serves as director of the Center for Bioethics, and an attending physician in the pediatric intensive care unit, and the executive director of the Institute for Professionalism & Ethical Practice.


The concepts of medical futility and rationing are often misunderstood and lead to significant consternation when resources are stretched and pediatric intensive care unit (PICU) beds are unavailable. While the two concepts overlap, each has its own distinct application and moral justification. Most importantly, we should avoid using one to justify the other. Bioethics professionals should assist critical care clinicians in clarifying when each rubric should be applied as well as how to develop policies to standardize the approach.

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