Withholding and withdrawing dialysis from elderly ESRD patients: Part 1?A historical view of the clinical experience

Rothenberg, Leslie Steven

doi:10.1007/bf00451674

Cited by 25 publications

(13 citation statements)

References 34 publications

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“…For patients over age 80, median survival time on dialysis is less than two years (Tattersall, 2005). In Europe (including the U.K., which through the 1970s and 80s applied the most stringent age-specific criteria for treatment), the numbers are comparable (Rothenberg, 1992;Stanton, 1999). Over half of European patients undergoing dialysis in 2003 were over age 65 (Sims, Cassidy, & Masud, 2003).…”

Section: The Emergence Of Geriatric Dialysismentioning

confidence: 99%

The value of “life at any cost”: Talk about stopping kidney dialysis

Russ

Shim

Kaufman

2007

Social Science & Medicine

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With the trend toward an older, sicker dialysis population in the USA, discussions of ethical issues surrounding dialysis have shifted from concerns about access to and availability of the therapy, to growing unease about non-initiation and treatment discontinuation. Recent studies report treatment withdrawal as the leading cause of death among elderly dialysis patients. Yet, the actual activities that move patients toward stopping treatment often remain obscure, even to clinicians and patients themselves. This paper explores that paradox, drawing on anthropological research among patients over age 70, their families, and clinicians in two California renal dialysis units. It concludes that many older patients sacrifice a sense of choice about dialysis in the present to maintain "choice" as both value and possibility for the future. Yet, patients desire more information and communication, provided earlier in their illness, about prognosis, how long they can expect to be on dialysis, and what the impact of the treatment will be on their daily lives. That, with time, there is a transition to be made from dialysis as "treatment" to end of life care could be better explained and managed to alleviate patients' confusion and unneeded isolation.

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Section: The Emergence Of Geriatric Dialysismentioning

confidence: 99%

The value of “life at any cost”: Talk about stopping kidney dialysis

Russ

Shim

Kaufman

2007

Social Science & Medicine

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“…The acceptance of government-mandated strategies will be variable. Although paid organ donation may be popular with the public (75), age-based rationing will certainly be controversial (84). How both the nephrology community and the general public ultimately deal with these and related issues remains to be seen.…”

Section: Resultsmentioning

confidence: 99%

The Coming Fiscal Crisis

Andersen

Friedman

2013

Clinical Journal of the American Society of Nephrology

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SummaryNephrologists in the United States face a very uncertain economic future. The astronomical federal debt and unfunded liability burden of Medicare combined with the aging population will place unprecedented strain on the health care sector. To address these fundamental problems, it is conceivable that the federal government will ultimately institute rationing and other budget-cutting measures to rein in costs of ESRD care, which is generously funded relative to other chronic illnesses. Therefore, nephrologists should expect implementation of cost-cutting measures, such age-based rationing, mandated delayed dialysis and home therapies, compensated organ donation, and a shift in research priorities from the dialysis to the predialysis patient population. Nephrologists also need to recognize that these changes, which are geared toward the population level, may make it more difficult to advocate effectively for the needs of individual patients.

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“…In its 1991 report, the Institute of Medicine (USA) supported the position that age alone should never be a criterion when it concluded, %.. Chronological age was considered and explicitly rejected by the committee as a criterion of patient acceptance, since it does not measure the ability of individuals to benefit from a treatment" [13,14].…”

Section: Elderly-patient/doctor Relationshipmentioning

confidence: 98%

“…; etc. Saving life should take priority over economic or other goals [13]. In this process, the physician must be alert to avoid the trap that disguises, as clinical judgement, economic decisions imposed by the society or its institutions.…”

Section: Elderly-patient/doctor Relationshipmentioning

confidence: 99%

Should the elderly be denied dialysis?

Oreopoulos

1994

Geriatric Nephrol Urol

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Withholding and withdrawing dialysis from elderly ESRD patients: Part 1?A historical view of the clinical experience

Cited by 25 publications

References 34 publications

The value of “life at any cost”: Talk about stopping kidney dialysis

The value of “life at any cost”: Talk about stopping kidney dialysis

The Coming Fiscal Crisis

Should the elderly be denied dialysis?

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