Ethical issues in geriatric nephrology: overview

Developments in medical care over the past five to six decades have provided remarkable life-sustaining technologies (LST) that have contributed to prolongation of the life span of patients, as well as to a general increase in health and well-being. End-stage renal disease (ESRD) treatment is a prototype of these LST treatments and of the issues surrounding provision of chronic/catastrophic care. This remarkable progress has been accompanied by ethical dilemmas that include allocation of scarce resources, and initiation and termination of care with LST. Consideration of these ethical dilemmas are especially poignant for the elderly, because they raise "hard choices" and there are no easy answers to these ethical dilemmas.