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When you have a serious illness, you may suffer from physical discomfort, such as pain, difficulty breathing, nausea (stomach upset) or fatigue. You may also have feelings of psychological distress, such as anxiety or depression, or feelings of spiritual distress. Your healthcare providers may provide medical therapies to treat or manage your illness, for example, antibiotics to treat pneumonia. In addition, you may receive care that helps you feel more comfortable, but does not treat or cure your illness. This type of care is called "comfort" or palliative (PAL-lee-uh-tiv) care.

T HIS OFFICIAL STATEMENT OF THE A MERICAN T HORACIC S OCIETY WAS ADOPTED BY THE ATS B OARD OF D IRECTORS , M ARCH 1997. SUMMARY American Thoracic Society (ATS) members, as health care practitioners caring for critically ill patients in intensive care units (ICUs) or as ICU directors, commonly must make decisions that allocate ICU resources. Some decisions necessitate prioritization of ICU beds while others limit access to particular scarce resources. Although these decisions arise when providing medical care for ICU patients, they occur in a larger context that includes ethical, economic, social, and legal considerations. In this context health care systems in the United States and in other countries face the consequences of increasing demand for expensive health care services in times of limited financial resources and competing societal needs. If one accepts the premise that demand for health care resources will inevitably outstrip financial constraints, one then must face the basic question of how to allocate those resources fairly. How health care organizations will meet increasing demand for services within financial constraints raises specific questions relating to the fair allocation of ICU resources

The development of efficient DNA sequencing techniques as well as more recent advances in recombinant DNA technology have brought about a new phase in the diagnosis and treatment of pulmonary diseases. The Human Genome Project will likely identify abnormal genes that contribute to a significant number of pulmonary disorders (Table 1). This Project will provide the foundation for the development of numerous genetic tests, and it will eventually lead to the treatment of genetic diseases. As methods for genetic testing and treatment are developed and used, the complexities of decision-making by pulmonologists will increase, forcing them to face questions not previously encountered. Answering these questions will require a greater understanding of the medical and social implications of genetic disorders. In any discussion of medical genetics, it is important to realize that the scientific process generally evolves in three phases. The first is the descriptive phase, in which traits or clinical characteristics are recognized and familial associations are noted. The second phase is the information phase, in which the genes linked to particular traits or disorders are identified, enabling the development of diagnostic and prognostic genetic tests. The third phase is the development of treatment techniques based upon discoveries in the second phase. The chronologic gap between the development of diagnostic and therapeutic procedures for genetic disorders (Figure 1) creates ethical dilemmas that cannot be resolved by simply referring to the old ethics. Currently, because of the infancy of the field of gene identification, pulmonary physicians are more likely to encounter ethical questions pertaining to the information phase, including the issues of informed consent for testing, test result confidentiality, and selective abortion based on genetic information. The ethical implications of both somatic and germ-line gene therapy, though perhaps not of immediate concern to a practitioner, are likely to become increasingly important in the next several decades. Through the use of examples familiar to most pulmonologists, an effort is made to present guidelines that can be used in confronting ethical dilemmas pertaining to both genetic testing and gene therapy.