Duke University Medical Center, Durham, NC 27710, USA.
Am J Bioeth. 2012;12(1):1-9. doi: 10.1080/15265161.2011.634483.
Periodic and unexpected shortages of drugs, biologics, and even medical devices have become commonplace in the United States. When shortages occur, hospitals and clinics need to decide how to ration their available stock. When such situations arise, institutions can choose from several different allocation schemes, such as first-come, first-served, a lottery, or a more rational and calculated approach. While the first two approaches sound reasonable at first glance, there are a number of problems associated with them, including the inability to make fine, individual patient-centered decisions. They also do not discriminate between what kinds of patients and what types of uses may be more deserving or reasonable than others. In this article I outline an ethically acceptable procedure for rationing drugs during a shortage in which demand outstrips supply.
在美国，药品、生物制剂，甚至医疗器械的定期和意外短缺已经司空见惯。当短缺发生时，医院和诊所需要决定如何配给可用库存。在这种情况下，机构可以从几种不同的分配方案中进行选择，例如先来先服务、抽签，或者更合理和有计划的方法。虽然乍一看前两种方法听起来合理，但它们存在许多问题，包括无法做出精细的、以个体患者为中心的决策。它们也没有区分什么样的患者和什么样的用途比其他患者和用途更值得或更合理。在本文中，我概述了一种在供应超过需求的短缺期间配给药物的伦理上可接受的程序。
