Scarcity in the intensive care unit: principles of justice for rationing ICU beds.

Difficult dilemmas arise when resources become scarce in intensive care units (ICUs). When there are fewer beds available than patients who need them, how are those beds to be distributed? In this report, I discuss such rationing dilemmas from the context of John Rawls' theory of justice. Principles of justice can be chosen by clinicians and used to set priorities in the distribution of scarce ICU beds. These principles consist of a ranking of patients based on available prognostic data. Such a ranking would be the most fair way of distributing scarce ICU beds within a Rawlsian conception of justice. It is a ranking that would be chosen by the patients themselves, were they able to consider the matter from a rational and impartial perspective.