Dialysis for everybody? At any cost?

Area of Science:

• Medical Ethics
• Health Economics
• Nephrology

Background:

• The prevailing
• mechanical disease model
• frames disease as a biological disorder, potentially leading to unlimited medical intervention.
• This approach has escalated healthcare expenditures and altered the perception of death as a prolonged process.
• Equity in healthcare mandates equal treatment opportunities, yet resource allocation for chronic dialysis presents ethical challenges.

Purpose of the Study:

• To critically evaluate the ethical implications of resource allocation in renal replacement therapy (RRT).
• To propose alternative criteria for initiating or withdrawing RRT based on individual patient well-being and quality of life.
• To advocate for a shift from a purely survival-driven approach to one that prioritizes a holistic view of patient care.

Main Methods:

• Ethical analysis of current medical practices and healthcare expenditure.
• Review of established principles of medical ethics, including equity and the principle of "avoiding harm."
• Reference to "Clinical Practice Guidelines on Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis" for ethical and methodological frameworks.

Main Results:

• The current model of RRT, heavily reliant on the mechanical disease model, consumes a disproportionate amount of healthcare resources (2% of total expenditure in Italy for 41,000 patients).
• Excluding patients based on statistical parameters or risk factors is ethically unsound.
• Decisions regarding RRT should consider individual patients' capacity to maintain essential human characteristics and their perspective on the proportionality of means to outcomes.

Conclusions:

• Ethical RRT resource allocation necessitates a move beyond mere survival metrics to encompass quality of life.
• Shared decision-making, focusing on individual patient values and the proportionality of treatment, is crucial for ethical RRT management.
• Failure to address these ethical dilemmas risks eroding the doctor-patient relationship and necessitating politically mandated resource allocation, potentially compromising medical ethics.