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Thursday, December 22, 2016


All in a Day’s Work — Equity vs. Equality at a Public ICU in Brazil

Flávia R. Machado, Ph.D.
N Engl J Med 2016; 375:2420-2421December 22, 2016DOI: 10.1056/NEJMp1610059
“Of all forms of inequality, injustice in health care is the most shocking and most inhumane.” — Martin Luther King, Jr.
We begin another day at 7:00 a.m., and once again we need to decide who will get an intensive care unit (ICU) bed after an elective surgical procedure. A 55-year-old grandmother with colon cancer? An elderly man with liver metastases? A young woman suffering from pain who needs an arthrodesis to keep working so she can continue to feed her family? Should we choose or deny patients because they have cancer? Should we choose on the basis of age? On patients’ previous quality of life? Or on social impact, if, for instance, one patient has four children to raise? Should we give the bed to a patient whom we’ve already had to refuse once? Or should we perhaps just stop playing God and give it to whoever asked first?
Every day, all around the world, intensivists face such cruel choices. And deciding which patients will have elective surgery is not even our most hideous task; emergency admissions are far worse. Death is probably not imminent for a patient who is denied the chance to have a tumor removed, but some patients will die without immediate intensive care to sustain their lives./.../

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