Pulling the Drug Out From Underneath: Ethical Considerations in the Discontinuation of the Antimalarial Quinidine

In 2017, the pharmaceutical company Eli Lilly announced it would stop manufacturing quinidine, the only Food and Drug Administration-approved treatment for severe malaria in the United States at the time. This decision left critically ill patients and their providers without access to the standard of care and created dangerous delays in obtaining life-saving therapy. As providing access to essential medications and minimizing preventable harm are fundamental aspects of ethical healthcare, Eli Lilly's action effectively prevented the delivery of ethical care to patients across the country. This case raises urgent and essential questions regarding the ethical obligations of a for-profit company when faced with conflicting interests and the ability of the broader healthcare community-including government agencies, hospital systems, and professional societies-to safeguard ethical patient care. We examined how the absence of enforceable accountability and oversight throughout the healthcare system allowed the actions of a single corporate entity to undermine the system's ethics without opposition. We propose interventions including amended production contracts, expedited regulatory approval of essential therapies, and the development of multidisciplinary advisory bodies to promote and protect the delivery of ethical care. As such conflicts will inevitably recur, proactive, collaborative, and enforceable mechanisms that center ethical patient care are urgently needed.