Ethical Implications of Drug Shortages

  • Jeffrey S. JacobsEmail author


Drug shortages have become a ubiquitous occurrence at most perioperative facilities. Dealing with these shortages involves not just administrative challenges, but opens a Pandora’s Box of ethical quandaries. This chapter reviews: the causes of medication shortages from manufacturing to distribution, the ethical discussions that arise when dealing with medication shortages from varying perspectives, and the challenges of finding definitive solutions.


Medication Drug Shortages Group Purchasing Organizations Drug Manufacturer Food and Drug Administration Hoarding 


  1. 1.
    American Society of Anesthesiologists. Drug Shortage Survey. 2012. Accessed on 13 Mar 2014.
  2. 2.
    US Department of Health and Human Services, Food and Drug Administration, A Review of FDA’s Approach to Medical Product Shortages. Silver Spring: US Dept of Health and Human Services, Food and Drug Administration; 2011. p. 8. Accessed 18 Feb 2015.
  3. 3.
    Fox ER, Birt A, James KB, Kokko H, Salverson S, Soflin DL. ASHP guidelines on managing drug product shortages in hospitals and health systems. Am J Health-Syst Pharm. 2009;66(15):1399–406.CrossRefPubMedGoogle Scholar
  4. 4.
    Barlas S. Manufacturers and hospitals spar over drug shortage reporting. PT. 2014;39(3):152, 215.Google Scholar
  5. 5.
    Wilson D. Deepening drug shortages. Health Aff. 2012;31(2):263–6.CrossRefGoogle Scholar
  6. 6.
    American Hospital Association. Survey on drug shortages. Washington, DC: American Hospital Association; 2011. Accessed on 13 Mar 2015.
  7. 7.
    Bedard M. Drug shortages: can we resolve the problem? Can J Anesth. 2013;60:523–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Woodcock J, Wosinska M. Economic and technical drivers of generic sterile injectable drug shortages. Clin Pharmacol Ther. 2013;93(170–6):174–5.Google Scholar
  9. 9.
    Golembiewski J. Drug shortages in the perioperative setting: causes, impact, and strategies. J Perianesth Nurs. 2012;27(4):286–92.CrossRefPubMedGoogle Scholar
  10. 10.
    American Society of Anesthesiologists. Statement on the ethical consideration with drug shortages. ASA Committee on Ethics. 2013.
  11. 11.
    O’Donnell JT, Vogenberg FR. Drug shortages pose problems for P&T committees in accountable care organizations. PT. 2013;38(7):404–6.Google Scholar
  12. 12.
    Center for Disease Control. Protect patients against preventable harm from improper use of single-dose/single-use vials. 2012. Accessed 19 Feb 2015.
  13. 13.
    Food and Drug Administration. Strategic plan for preventing and mitigating drug shortages. Food and Drug Administration. 2013.
  14. 14.
    Premier, Inc. Drug Shortages Continue to Pose Patient Safety Risks and Challenge Providers, According to Premier, Inc. Survey. 2014.
  15. 15.
    Kaakeh R, Sweet BV, Reilly C, Bush C, DeLoach S, Higgins B, Clark AM, Stevenson J. Impact of drug shortages on US health systems. Am J Health Sys Pharm. 2011;68(19):1811–9.CrossRefGoogle Scholar
  16. 16.
    Weaver JM. Why are there so many drug shortages? Anesth Prog. 2010;57:89–90.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Rosoff PM, Patel KR, Scates A, et al. Coping with critical drug shortages: an ethical approach for allocating scarce resources in hospitals. Arch Intern Med. 2012;172(19):1494–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of AnesthesiologyCleveland Clinic FloridaWestonUSA

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