Bioethics Blogs

Need to Ration ICU Access

Paul E. Marik published “The Cost of Inappropriate Care at the End of life Implications for an Aging Population” in the American Journal of Hospice and Palliative Care.

Marik presents the case of an 86-year-old female who spent almost 3 months in ICU prior to her death. The fully allocated hospital costs for this patient were estimated to $5100 per day.  That is a lot.  But the stronger argument may focus on the patients deprived of the opportunity to benefit from ICU care when this patient was there and the ICU was full.   

With the increasing age of the population and the projected increased demand for ICU beds, he reviews the benefits and burdens of admitting elderly patients to the ICU.

  • Elderly patients patients (older than 65 years) account for only 11% of the US population yet they account for 34% of health care expenditure. 
  • The disproportionate usage of health care costs by elderly patients is in striking contrast with that of other Western Nations. It is likely that these differences are largely due to variances in hospitalization and the use of high technology health care resources at the end of life. 
  • The United States has 8 times as many intensive care unit (ICU) beds per capita when compared to other Western Nations. 
  • In the United States, elderly patients currently account for 42% to 52% of ICU admissions and for almost 60% of all ICU days.
  • A disproportionate number of these ICU days are spent by elderly patients before their death. 
  • In many instances, aggressive life supportive measures serve only to prolong the patient’s death.

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.