Pelonero A L, Elliott R L
Medical College of Virginia, Virginia Commonwealth University, Richmond 23298.
Hosp Community Psychiatry. 1990 Aug;41(8):878-80. doi: 10.1176/ps.41.8.878.
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.
在一家大型州立医院的患者群体中，鉴于氯氮平的药物成本及其强制监测系统，临床上符合接受氯氮平治疗条件的难治性精神分裂症患者数量，可能超出了医院的支付能力。作者回顾了选择患者的临床标准，并讨论了两条可能有用的伦理原则：基于为最多患者带来最大益处的原则（依据出院可能性和对治疗环境的益处等预期结果）来选择患者，以及优先考虑治疗选择最少的患者。亲属施加的要求给某一亲属使用氯氮平的家庭压力等问题也必须加以应对。
