Often, when a person is brought into the hospital, many complex and challenging decisions must be made rapidly. Unfortunately, some of those decisions must be made with financial limitations in mind. Medications, tests and services are often costly and limited in availability. Hospitals faced with tremendous economic pressures due to the rising costs of healthcare, the growing numbers of uninsured patients, lowered Medicaid and Medicare reimbursements, find that they can only supply limited amounts of costly therapies.

To determine how its members cope in such a healthcare environment, the Society of Critical Care Medicine (SCCM) recently conducted an opinion poll of more than 5,000 SCCM members. The results of the poll were presented in Boston on Saturday at SCCM's Writers Workshop by Nicholas S. Ward, MD, Assistant Professor of Medicine at Brown University School of Medicine.

"This is a very serious issue," said Ward. "Over 75 percent of the respondents indicated that they would withhold a medication, test or service that is limited in supply at their hospital from a patient who might receive limited benefit from it and give it to a patient who they felt would better benefit from it."

Many physicians feel that they are being asked to make impossible decisions regarding patient care because of limited resources. In some cases, so-called "bedside rationing" forces a physician to choose which patients will receive life saving therapies and which won't.

Fifty four percent of those responding to the poll indicated that they have also withheld a medication, test or service in instances where they thought that the cost outweighed the potential benefits to a patient.

"We also found that the respondents had mixed opinions on whether rationing a therapy was unethical," Ward said. "In cases where there was a clear indication that a patient would benefit from a therapy, over 85 percent of the respondents said that it would not be ethical to withhold the therapy. But in cases where a therapy might prove to be of limited benefit, only 25 percent of the respondents thought it would not be ethical."

"But the larger question is, who decides if a therapy is of limited benefit? Are such decisions based upon things like clinical evidence or financial pressures to keep costs down?" he continued.

Ward pointed to a situation he was involved in where an elderly woman with multiple health problems had been brought into the Emergency Department and had been seen by several specialists and was receiving some costly therapies. He diagnosed her with sepsis and recommended that she receive a new and expensive medication that was in limited supply at the hospital. The other physicians questioned his judgment, citing the fact that the woman had so many health problems that affected her quality of life that it wasn't worth using such an expensive medication on her when other people might better benefit from it.

When asked who should decide when and how limited healthcare resources should be distributed, the respondents overwhelmingly chose "a national multidisciplinary task force developing rationing guidelines for implementation nationwide."

The Society of Critical Care Medicine is currently investigating the creation of such a task force. This task force, would address these issues.

More than 500 SCCM members responded to the poll, which was sent out to 5,500 members. Responses were kept anonymous.

The Society of Critical Care Medicine is the only professional organization devoted exclusively to the advancement of multidisciplinary, multiprofessional critical care. Members of the Society include intensivists, critical care nurses, critical care pharmacists, clinical pharmacologists, respiratory therapists and other professionals, which may include physician assistants, technicians, social workers, dieticians and members of the clergy.