Bioethics Blogs

Rationing – The Case of NICU and the Place of Cost-effectiveness Thresholds

Julian Savulescu will be delivering the next public lecture at the Australian Centre for Health Law Research:  “Rationing – The Case of NICU and the Place of Cost-effectiveness Thresholds” on May 18.

When health professionals are considering whether or not to provide life-sustaining treatment to a critically ill newborn infant, they often consider the best interests of the child. Frequently, they will consult with the infant’s parents, and take into account parents’ interests and their views about treatment for the child. However, there is one important ethical factor that health professionals do not necessarily consider, or (at least explicitly) acknowledge. Resource limitations and the effect of treatment of others are of fundamental importance for end of life decisions, even in well-resourced countries like Australia.

In this presentation Professor Savulescu will first set out the principles that should underlie resource allocation in a public health system. He reviews arguments for and against rationing. In the second half of the presentation Professor Savulescu will use existing cost effectiveness thresholds to shed light on the question of medical futility in intensive care. He draws on the examples of short-bowel syndrome, spinal muscular atrophy, neonatal ECMO and trisomy 18. 

  • How low a probability of survival is too low
  • How long a course of intensive care is too long? 
  • When are doctors justified in withholding treatment because of future quality of life? 

Rationing is inevitable in intensive care. However, for it to be ethical it must be transparent, consistent and rational.


Professor Julian Savulescu is the Uehiro Chair in Practical Ethics, Director of the Oxford Uehiro Centre for Practical Ethics at the Faculty of Philosophy, University of Oxford and Director of the Institute for Science and Ethics, Oxford Martin School at the University of Oxford.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.