Just health care rationing: a democratic decisionmaking approach.

Michael S. was born in 1984 to unmarried teenage parents who were without health insurance. He was born with necrotic small bowel syndrome. Surgery at-birth determined that he would not be able to process food in the normal way. Hence, he would have to remain in an intensive care unit, fed via total parenteral nutrition (TPN). After six months the hospital administrator approached the attending physician and pointed out that Michael was responsible for $250,000 in uncompensated care costs. Michael could live another six to eighteen months, which would mean potential uncompensated care costs of one million dollars. The administrator reminded the physician that this was the only hospital in town that provided charity care to the poor, and that if Michael remained in the hospital then the emergency room would have to be closed to all the poor, except those with true life-threatening medical problems. The state was willing to care for Michael and place him in a nursing home, but it would not provide TPN, which would mean Michael would die of infection and/or starvation within two weeks. 1