Financial toxicity and dialysis: Autonomy and truth-telling in resource-limited settings

Abstract

From an ethical perspective, resource limitations provide a challenge for healthcare providers. Handling disclosure of the financial details of treatment options in a way that empowers patients, even in the face of extreme poverty, requires careful consideration of the personal preferences and motivations of each patient. This article will consider the high costs of dialysis for patients experiencing extreme poverty in light of various ethical principles, including informed consent and truth-telling. It will conclude that a graduated method of disclosing the physical and financial burdens of each treatment option is the best way forward, particularly for healthcare workers engaged in resource-limited settings.

Key ethical challenges in providing dialysis in low resource settings — A view from the trenches

“…Kendal and Bhatt discuss their concerns that patient autonomy around dialysis initiation may be limited when they are poor and unable to afford dialysis costs [9]. The authors argue that this could occur in two situations: First, when nephrologists may paternalistically withhold information about dialysis or transplant, believing that patients may be distressed at their inability to afford these treatments.…”

“…Kendal and Bhatt propose a gradual disclosure of information in increasing order of costs as a solution to avoid this dilemma. They suggest that the diagnosis be disclosed first, followed by (cheaper) conservative care options and lastly, only if the patient desires to hear more, should dialysis, its costs and associated "financial toxicity" be disclosed [9].…”