Ethical and clinical considerations in selecting patients who will receive clozapine.
In a large state hospital population, more treatment-resistant schizophrenic patients may be clinically eligible to receive clozapine than the hospital can afford to pay for, given the costs of the medication and its mandatory monitoring system. The authors review clinical criteria for selecting patients and discuss two ethical principles that might be useful: select patients on the principle of providing the greatest good for the greatest number of patients (based on expected outcomes such as likelihood of discharge and benefit to the milieu) and give priority to patients for whom the fewest treatment alternatives are available. Issues such as family pressures for administration of clozapine to a relative must also be dealt with.
Medical College of Virginia, Virginia Commonwealth University, Richmond 23298.
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Pelonero
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Elliott
D000328:Adult; D000380:Agranulocytosis / Q000139:chemically induced; D003024:Clozapine / Q000009:adverse effects / Q000627:therapeutic use*; D003363:Cost Control / Q000331:legislation & jurisprudence; D003984:Dibenzazepines / Q000627:therapeutic use*; D028663:Ethical Theory; D004992:Ethics, Medical; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence; D037141:Mandatory Programs; D028642:Persons with Psychiatric Disorders; D018579:Patient Selection; D040841:Resource Allocation; D018570:Risk Assessment; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics; D012565:Schizophrenic Psychology; D012926:Social Control, Formal; D014481:United States
D003984:Dibenzazepines; D003024:Clozapine