Drug Shortages: 10 Ethics Rules for Hospitals

Finally, Rosoff says, in the rare events in which two clinically equivalent patients need a drug for which supply is only sufficient for one, "a coin will be tossed to choose between them."

The issue is increasingly a controversial one because of unpredictable shortages, especially involving expensive drugs that sometimes find their way into other routes of sale, the so-called grey market. Sometimes raw materials are contaminated, or there are quality issues with the manufacturing process, or the manufacturer just decides to discontinue production.

In an accompanying editorial, Paula Rochon, MD, and Jerry Gurwitz, MD, of the Women's College Research Institute in Toronto say Rosoff and his colleagues "serves as a wake-up call to clinicians to become better educated about and more engaged in the issue of drug shortages.

"Clinicians need to be vigilant about reviewing the drug shortage alert they receive because these alerts may directly affect their patients and their plans for patient care," they wrote.