The sound of silence: rationing resources for critically ill patients

Introduction Thirty years ago, the rationing of healthcare was invisible and silent. Recently, however, healthcare expenditures have become a major focus of public policy. As we look for ways to control spending, we become more aware of the economic trade-offs involved in every healthcare decision. Allocating resources to one service means less left for other services; allocating resources to one patient means less resources available for others. Rationing is becoming more publicly visible and explicit at every level of the healthcare system. However, in many intensive care units (ICUs) rationing still remains silent – implicitly conducted and inadequately discussed.