The ethics of providing intensive care in managed care organizations.

To provide adequate and equitable care of critically ill patients, managed care organizations need to dedicate a reasoned proportion of organizational resources to the provision of critical care, distribute these resources fairly, establish appeal mechanisms, and monitor the outcomes of critical care. As in any healthcare delivery system with limited resources, it is inevitable that there will be limits to highly technological and costly life-sustaining care. Patients, physicians, and plan administrators will need to collaborate to decide priorities for care, since difficult trade-offs will need to be made between types of care and between quality and cost of care. The use of life-sustaining treatments should be informed by patient preferences and guided by many of the established guidelines for the provision of critical care. Physicians who provide critical care in a managed care organization should provide the most skilled and compassionate care to critically ill patients within the constraints of the ethically acceptable guidelines.