Oral Presentation Australasian Association of Bioethics & Health Law and New Zealand Bioethics Conference

Formulating an Ethics of Pharmaceutical Disinvestment: A Critical Interpretive Review (999)

Jessica Pace 1 , Tracey-Lea Laba 2 , Marie-Paul Nisingizwe 3 , Wendy Lipworth 1
  1. Sydney Health Ethics, University of Sydney, Camperdown, NSW, Australia
  2. The George Institute , UNSW, Sydney, NSW, Australia
  3. Graduate School, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

There is growing interest among pharmaceutical policymakers in how to “disinvest” from subsidised medicines. This is due to both the rapidly rising costs of healthcare and the increasing use of accelerated and conditional reimbursement pathways which mean that medicines are being subsidised on the basis of less robust evidence. It is crucial that disinvestment decisions are morally sound and socially legitimate, but there is currently no framework to facilitate this. We therefore conducted a critical interpretive review of the bioethics literature in order to identify ethical principles and concepts that might be relevant to pharmaceutical disinvestment decisions. We searched the databases PubMed, MEDLINE/EMBASE, CINAHL, the Cochrane Library, Google Scholar, PsychINFO and Sociological Abstracts using terms related to disinvestment and ethics in November 2018. One reviewer appraised candidate publications and extracted data. Articles were then analysed thematically until no new ethical principles or concepts were emerging, and results were refined by discussion amongst the authors. Included papers pointed to a number of key ethical considerations—both procedural and substantive—that need to be considered when making pharmaceutical disinvestment decisions. These principles do not, however, provide practical guidance so we present a framework outlining how they might be applied to different types of disinvestment decisions. We also argue that even the most rigorous ethical reasoning may be overridden by moral intuitions and psychological biases and that it is important not to assume that disinvestment will be a socially or politically feasible solution to the problem of unsafe, ineffective or low-value care.