The dilemma of the last bed: the allocation of limited resources in reanimation.

Abstract

Modern reanimation is extremely expensive but not very “productive” in merely economic terms. In fact it only offers high cost benefits to a few “users”. In a general context of the reduction of the resources to the health service, in such a particular sector like that of the critical area, ethical reflection regarding the criteria for the micro-allocation of limited resources becomes essential.

After dealing with the nature and aims of reanimation, the possible causes of a reduction of the availability of beds in the reanimation department are taken into consideration, and also the modalities with which the physicians usually deal with the situation of the reduced availability of resources, and the guidelines for dealing with the triage situations.

The process of decision making in the use of health resources has to start from strict “clinical criteria” (the need and suitability for reanimation, emergency, etc.), together with the proportionality criteria of the therapy. Faced with situations of equal need the so-called temporality criteria (to offer treatment to whoever first comes under medical observation) or the prognosis criteria (to use the resources available for whoever has the greatest chance of benefiting from it) can be followed. The “score system” used in the field of reanimation to forecast the outcome can not used at present in the decision making process regarding an individual patient or in the triage procedures.

Confirming that the physician’s action, in all fields, has to be considered ethically it has to be underlined that there is a moral duty to administer the health resources correctly and also limit waste and prevent triage situations.