Clinical actions and financial constraints: the limits to rationing intensive care

This paper is concerned with the nature of rationing in intensive care. It reports a study of three intensive care units (ICUs) where resources were l imited. We describe two conceptualisations of rationing: hard rationing, wh ere there are absolute physical or financial constraints in place and soft rationing, in which clinicians and clinical managers, key actors in the org anisation, can relax or remove apparently binding constraints. This paper d emonstrates that, for the ICUs in this study, soft rationing was the norm. The existence of soft rationing was a function of three main factors: the n ature of intensive care, the current state of modelling of means-end relati onships in intensive care and network activity within and between ICU teams .