Who is too sick for the ICU

In this issue a paper by Joynt and Gomersall discusses the ethical issues in deciding which patients should receive life support in the form of mechanical ventilation. This is a particularly relevant topic in South African state hospitals, where intensive care beds are extremely limited yet the demand is potentially greater than in First-World countries because of our high incidence of severe trauma and infectious disease. Hospital administrators call for written admission policies, but developing these is a daunting task as few finite clinical criteria reliably predict death.