Clozapine rationing in a state mental hospital: reviewing a HEC's case consultation.
Clozapine (Clozaril) is a new, powerful, costly anti-psychotic medicine, with a possible serious side effect (agranulocytosis) that entails weekly blood monitoring. In a three hundred bed state mental hospital that is allotted thirty clozapine slots (high costs effectively rationing this drug), a woman with schizophrenia responds minimally to this medication. Her attending physician wishes to withdraw the medicine and give it to another patient with schizophrenia on the ward who might have a better response. The woman's family threatens to make a public outcry. Both the attending physician and the family ask the HEC for a consult.
Backlar
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Center for Ethics in Health Care, Oregon Health Sciences University.
McFarland
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BH
D000328:Adult; D003024:Clozapine / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D003659:Decision Making, Organizational; D034462:Dissent and Disputes; D016527:Drug Costs; D026724:Ethical Review; D017041:Ethics Committees / Q000592:standards*; D028741:Ethics Committees, Clinical; D033061:Ethics Consultation; D005260:Female; D006126:Group Processes; D015276:Health Care Rationing / Q000592:standards*; D006778:Hospitals, Psychiatric / Q000592:standards; D006783:Hospitals, State / Q000592:standards; D006801:Humans; D007258:Informed Consent; D018579:Patient Selection; D040841:Resource Allocation; D018570:Risk Assessment; D012559:Schizophrenia / Q000188:drug therapy*; D014481:United States; D028761:Withholding Treatment