Statement on the Ethical Considerations with Drug Shortages
Developed By: Committee on Ethics Last Amended: October 16, 2013 (original approval: October 16, 2013)
Shortages of drugs necessary for the practice of anesthesiology, critical care, and pain medicine create patient safety and public health hazards. Anesthesiologists have ethical responsibilities to participate in the development of solutions to this societal problem.
Anesthesiologists, as well as surgeons and other proceduralists, should consider postponing an elective procedure when the risks of proceeding might outweigh the risks of using medications that are alternative to those in short supply or unavailable.
If the anesthesiologist judges the risk of increased morbidity or mortality by using alternative medications to be negligible, then there is no need to discuss this issue when obtaining informed consent. However, if the anesthesiologist judges the added risk to be significant, then the discussion of alternative plans should be part of the informed consent process.
The collection of adverse events occurring as a result of drug shortages provides important information useful in the pursuit of a solution. Anesthesiologists should report these events to the appropriate entities for this purpose.
In the face of specific drug shortages, anesthesiologists should reassess customary practice patterns of drug usage to minimize drug wastage and safely maximize any limited supply.
Flexibility and adaptability in patient care may obscure the reality of potential harm created by drug shortages and should not be a substitute for pursuing a permanent solution.
Anesthesiologists should collaborate with colleagues, pharmacists, appropriate committees, institutional administrators, professional societies, and government agencies to manage issues, policies, and procedures related to drug shortages.
While stockpiling medications may be beneficial for a given institution, excessive accumulation and storage of drugs can result in shortages to other institutions and may be unethical.
Collectively, anesthesiologists have an ethical obligation to examine and manage shortages of drugs essential to safe practice. Therefore, professional medical organizations should identify statutes, regulations, and guidelines that impact the adequate supply of medications, and advocate for appropriate evidenced-based changes that would optimize their availability.