The changing physician-patient relationship in critical care medicine under health care reform.

American society and the medical profession have historically been dominated by a "single master" view that emphasizes unrestrained advocacy for individual patients and prohibits physicians, including those who work in critical care units, from being providers and rationers of health care services simultaneously. With its emphasis on universal access and cost containment, health care reform requires that society and the medical profession balance this individualistic ethic with a communitarian ethic that stresses proportional advocacy for all patients and encourages physicians and patients to help define the scope of services their health care institutions provide. Ideally, this balance will allow the transition from a "rule of rescue" in which large sums of money are spent on therapies that may have only marginal benefit to a "rule of reason" in which this money can be used for primary and preventive care.