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An Ethical Frameworkfor Allocating ScarceLife-SavingChemotherapy andSupportive Care Drugsfor Childhood Cancer Yoram UnguruConrad V. FernandezM. Brooke Bernhardt2016 год

An Ethical Framework for Allocating Scarce Life-Saving Chemotherapy and Supportive Care Drugs for Childhood Cancer
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Аннотация: Shortages of life-saving chemotherapy and supportive care agents for children with cancer are frequent. These shortages directly affect patients' lives, compromise both standard of care therapies and clinical research, and create substantial ethical challenges. Efforts to prevent drug shortages have yet to gain traction, and existing prioritization frameworks lack concrete guidance clinicians need when faced with difficult prioritization decisions among equally deserving children with cancer. The ethical framework proposed in this Commentary is based upon multidisciplinary expert opinion, further strengthened by an independent panel of peer consultants. The two-step allocation process includes strategies to mitigate existing shortages by minimizing waste and addresses actual prioritization across and within diseases according to a modified utilitarian model that maximizes total benefit while respecting limited constraints on differential treatment of individuals. The framework provides reasoning for explicit decision-making in the face of an actual drug shortage. Moreover, it minimizes bias that might occur when individual clinicians or institutions are forced to make bedside rationing and prioritization decisions and addresses the challenge that individual clinicians face when confronted with bedside decisions regarding allocation. Whenever possible, allocation decisions should be supported by evidence-based recommendations. "Curability," prognosis, and the incremental importance of a particular drug to a given patient's outcome are the critical factors to consider when deciding how to allocate scarce life-saving cancer drugs.
Год издания: 2016
Авторы: Yoram Unguru, Conrad V. Fernandez, M. Brooke Bernhardt, Stacey L. Berg, Kim Pyke-Grimm, Catherine Woodman, Steven Joffe
Издательство: Oxford University Press
Источник: JNCI Journal of the National Cancer Institute
Ключевые слова: Childhood Cancer Survivors' Quality of Life, Pharmaceutical studies and practices, Ethics and Legal Issues in Pediatric Healthcare
Другие ссылки: JNCI Journal of the National Cancer Institute (PDF)
JNCI Journal of the National Cancer Institute (HTML)
PubMed (HTML)