Quantity versus quality: ethics and provision of renal replacement therapy

50 years ago if one had renal failure the prognosis was certain death within a short timeframe. Now if one receives renal replacement therapy the prognosis has dramatically changed. But in this time of economic constraints and ever decreasing human resources are we now to be faced with the necessity to make choices about who receives replacement therapy? This paper looks at the ethics of providing treatment for large numbers but at the risk of 2nd class treatment, or selection of a few to receive the best treatment possible. The author asks what is the point of choice for the provision of therapy; before treatment has begun or having started who has the right to stop treatment and should there be criteria for discontinuing this treatment? The paper examines the ethical issues facing all the health care team especially those caring for the chronically ill. The financial benefits of one kind of therapy over the other are examined and again the author puts the question, is it economics that governs the treatment prescribed, or a real choice made with knowledge? The author has found that "hands on" health care teams are still aiming to treat the ever increasing workload but at what cost? How long can we continue to accept patients for treatment when we may be putting at risk other patients and the very people who are providing the care?