Ethical issues in selecting patients for treatment with clozapine: a commentary

Three ethical constructs of distributive justice--utilitarianism, Marxism, and the theories of John Rawls--are applied to selection of patients for treatment with clozapine. Elements of an ethical selection process include a means of monitoring the clinical effectiveness of the drug so that it is not wasted and procedures for ensuring that patients' rights to advocacy and due process are met. The authors suggest that a disproportionate number of patients with tardive dyskinesia may receive clozapine because clinicians and hospitals risk litigation if these patients continue to receive standard neuroleptics and experience worsening side effects.