April 13, 2011 | Posted By Sheila Otto, MA, BSN

A New York Times article, found here, regarding the current state of dialysis in this country was worth reading. However what was even more interesting (to me) was the range of comments that were subsequently submitted. The article recalled that dialysis as a treatment for end stage renal disease was first instituted in the 1960s as a life saving treatment which was intended to get patients back on their feet and return to the workplace. Today, it is used primarily in the elderly population and often in conjunction with other major co-morbidities, at times to stave off the grim reaper for a short time. The author questions whether this expensive intervention is in the best interest of the patient, or the best allocation of scarce resource dollars. 

Many of the comments agreed with the suggestion for a second look, given the limited benefits and the enormous costs of the expanded base. Others wrote that limiting life sustaining treatment was an immoral act; that targeting the elderly was patently unfair; that if we started limiting this service, it would be the first step down the slippery slope; and of course the ever present voice that we could have unlimited care if only we cut defense spending or foreign investment. 

What continually astounds me is the view that limits are unacceptable, yet we cannot expect taxes to rise and we should be prepared for decreases in government health care budgets. So who is supposed to pay? Somehow the rights of individuals always trump that of the society. No one can put a price tag on a life. If my demented 90-year-old mother can live another month with dialysis, she should be entitled, so the argument goes. As medical care has continued to expand with ever more expensive drugs and equipment, costs have risen dramatically. There are still, as we know , millions without any coverage as well as the insured who are being asked to pay larger premiums, as one would expect, to keep up with the rising costs.  Small businesses and state governments are struggling with these increases to the point of crisis. It would seem that distributive justice would dictate first, access to all and then fair distribution of services that we can afford. Any way we cut it, there are limits. Why should any group be exempt?

3 comments | Topics: Bioethics in the Media , End of Life Care , Philosophy



benita wrote on 04/13/11 11:07 AM

While I mostlyagree I have to question the cut off point .. how do we determine who DOES qualify for this life extending, or any such, technology? How do we determine an end point? Does a 50 year old qualify ... how about an otherwise healthy, active 70 year old? And how do we create a cut-off point that either can't be corrupted or is void of the appearance of corruption for those who have money or influence?
sheila otto

sheila otto wrote on 04/13/11 4:40 PM

Many factors can determine a "cut-off"...age is A factor but not necessarily the whole package. The point is that we need to think in terms of reexamining a lot of what we do. If it's all about me, then society's needs be damned. Everything I read says we simply cannot continue down this path.In terms of the rich buying more care.....as Jimmy Carter once said, "Life isn't fair" and we already have a multi-tiered system with varying degrees of coverage. Transparency is essential

benita wrote on 04/14/11 11:38 PM

Just caught this article on Newswise one of my fave sites .. it raises an interesting issue re: transparancy. Smacks a bit of big brother .. however ... http://www.newswise.com/articles/view/575732/?sc=c22&utm_source=twitterfeed&utm_medium=twitter

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.