Since its inception during the 1950s polio epidemic in Copenhagen, the specialty of intensive care has reckoned with the ethical distribution of life-sustaining treatments in the face of continued high demand. The first intensive care unit (ICU) was established in the UK in 1966; in 2023 there are now approximately 210 such units, with an average of 6.6 beds per 100,000 population. This is approximately half of that in other comparable nations (11.5 beds per 100 000 in the EU) and a quarter of the resource of Germany.1

With the UK population living longer, and with increasingly complex medical profiles, it is imperative that ICU teams are skilled in allocating the resources available to them to maximize patient benefit – however defining ‘benefit’ is challenging. In this article, we explore the patient and systemic factors, and the ethical principles by which this ‘maximal benefit’ may be determined. We also examine the impact of the recent coronavirus disease (COVID-19) pandemic on resource allocation, as an example of acute resource scarcity. We consider the legal framework that may influence resource allocation and decision-making, and the degree to which resource allocation is covered by the current UK intensive care medicine (ICM) training curriculum. An example case is provided to help you consider all the factors involved in resource allocation and ICU admission (Figure 1).