Drug Shortages: 10 Ethics Rules for Hospitals

When precious medications run low, how should clinicians decide who should get the benefit?

That's the thorny question clinicians at Duke University Medical Center are attempting to answer with an ethically defensible drug rationing plan which aims to help healthcare providers make fair and equitable choices.

"This plan obeys a simple, straightforward set of rules for fairness and allocation that was vetted by a large number of people—physicians, nurses, social workers, ethicists as well as community members and patient representatives," says Philip Rosoff, MD, Duke's director of clinical ethics and the principal investigator of the Duke project.

In an attempt to avoid providers making decisions that favor VIPs such as "a donor, the brother-in-law of the chief medical officer or the mayor," versus the VUP, the person with no insurance, Rosoff says, the policy stipulates explicitly that "there are no special people. Does that mean we wouldn't come under pressure? We could. But it's written into the policy of the hospital, so the downside is that violating that could mean one helluva lawsuit."