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Clozapine rationing in a state mental hospital: reviewing a HEC's case consultation
1Center for Ethics in Health Care, Oregon Health Sciences University.
Insights
This case highlights the ethical dilemma of rationing expensive clozapine, a crucial antipsychotic, when a patient shows minimal response but faces family opposition to treatment withdrawal.
Area of Science:
- Psychiatry and Pharmacology
- Bioethics
- Health Economics
Background:
- Clozapine is a potent antipsychotic with a risk of agranulocytosis, necessitating weekly blood monitoring.
- High costs of clozapine lead to rationing, with limited slots available in psychiatric facilities.
- A patient with schizophrenia exhibits minimal response to clozapine, posing a clinical challenge.
Abstract:
Clozapine (Clozaril) is a new, powerful, costly anti-psychotic medicine, with a possible serious side effect (agranulocytosis) that entails weekly blood monitoring. In a three hundred bed state mental hospital that is allotted thirty clozapine slots (high costs effectively rationing this drug), a woman with schizophrenia responds minimally to this medication. Her attending physician wishes to withdraw the medicine and give it to another patient with schizophrenia on the ward who might have a better response. The woman's family threatens to make a public outcry. Both the attending physician and the family ask the HEC for a consult.