PMID: 7536057Jan 1, 1995Paper

Clinical and ethical perspectives on rationing of high-cost drugs

The Annals of Pharmacotherapy
T I Poirier, V J Giannetti

Abstract

To analyze the use of high-cost drugs from a clinical decision-making approach and ethical perspectives on rationing. The case of a 26-year-old intravenous drug user with AIDS raises issues of how to ration high-cost drugs such as foscarnet, monoclonal antibodies (MAbs) for septic shock, and granulocyte colony-stimulating factor. Should a patient with a terminal illness receive high-cost drugs given limited healthcare resources? Necessary clinical information including treatment algorithms, risk to benefit ratios, and cost-effectiveness data are evaluated. Rationing, especially bedside rationing, by the clinician is rejected because it is contrary to the clinician's ethical obligation of beneficence and nonmaleficence. Patient autonomy and desires may also conflict with society's interest in equitably distributing resources. Treatment could be denied if costs exceed benefits for the outcomes and thus deny resources to others who have more basic healthcare needs. There is no obligation to offer medically futile care or for the patient to accept extraordinary medical care. An ethical argument for rationing cannot be made because of the lack of a clear clinical and societal consensus on specific criteria for rationing of healthcar...Continue Reading

References

Jun 15, 1990·Annals of Internal Medicine·L J SchneidermanA R Jonsen

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Citations

Feb 15, 2001·Journal of Acquired Immune Deficiency Syndromes : JAIDS·M J GreenP A Ubel

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