Abstract
The demographics of clinical populations can predict the demand for critical care services. Both Japan and the United States forecast a substantial expansion of the aged population. The inevitable consequence is a sharp increase in the number of patients who may wish to be admitted to an intensive care unit. No economy can meet the predicted demand. As a consequence, some rationing of critical care services is inevitable. Such rationing cannot be done by rules, but rather must reflect a system of values that is clearly stated and compassionately applied. Each critical care physician must undertake introspection to understand his or her own values and ensure that those values are transparent in any rationing process. Values such as integrity, honesty and respect for the personal views of patients and families can enlighten difficult decisions regarding the goals and duration of critical care services.
