Rosoff Philip M, Patel Kuldip R, Scates Ann, Rhea Gene, Bush Paul W, Govert Joseph A
Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA.
Arch Intern Med. 2012 Oct 22;172(19):1494-9. doi: 10.1001/archinternmed.2012.4367.
The number of critical medication shortages in the United States has reached an unprecedented level, requiring decisions about allocating limited drug supplies. Ad hoc decisions are susceptible to arbitrary judgments, revealing preformed biases for or against groups of people. Health care institutions lack standardized protocols for rationing scarce drugs. We describe the principles on which an ethically justifiable policy of medication allocation during critical shortages was created at our hospital. Based on supportable scientific evidence and with all clinically similar patients treated as similarly deserving of consideration, drugs were distributed according to a hierarchy of clinical need and predicted efficacy. We explain the ethical rationale for the procedures we adopted, how the policy was implemented at a large academic medical center, and more than 1 year of experience with a number of different medications. Our experience has demonstrated the feasibility and utility of formulating a rational and ethically sound policy for scarce resource allocation in an academic teaching hospital that could be used in a variety of health care settings. The method has proven to be reliable, workable, and acceptable to clinicians, staff, and patients.
美国关键药物短缺的数量已达到前所未有的水平，这就需要做出关于分配有限药品供应的决策。临时决策容易受到随意判断的影响，暴露出对特定人群的既有偏见。医疗机构缺乏用于分配稀缺药物的标准化方案。我们描述了我院在严重短缺期间制定符合伦理道德的合理用药分配政策所依据的原则。基于可靠的科学证据，并将所有临床情况相似的患者视为同样值得考虑的对象，根据临床需求等级和预期疗效来分配药物。我们解释了所采用程序的伦理依据、该政策在一家大型学术医疗中心的实施方式，以及在一年多时间里对多种不同药物的经验。我们的经验证明了在学术教学医院制定合理且符合伦理道德的稀缺资源分配政策的可行性和实用性，该政策可用于各种医疗环境。事实证明，这种方法可靠、可行，并且为临床医生、工作人员和患者所接受。
