Semin Respir Crit Care Med 2012; 33(04): 382-392
DOI: 10.1055/s-0032-1322402
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Ethical and Economic Impact of Defaults

Mark D. Siegel
1   Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, Connecticut
,
Renee Stapleton
2   Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont
,
Hannah Wunsch
3   Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York
4   Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
› Author Affiliations
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Publication History

Publication Date:
08 August 2012 (online)

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Abstract

Medical care offered to the critically ill often occurs by default, unfolding automatically unless concerted effort is made to do otherwise. In their scope, defaults include traditional approaches to treatment and decision making, as well as policies deliberately set to promote specific health outcomes. Defaults are ethically sound to the extent that they foster patient well-being and autonomy. Unfortunately in practice, some defaults lead to ineffective, unwanted, and expensive care. This article reviews the ethical and economic impact of defaults, paying special attention to their influence on the practice of cardiopulmonary resuscitation and admission to the intensive care unit.