Should AIDS patients be dialyzed?

Should AIDS patients be dialyzed? For asymptomatic HIV carriers and patients with ARC developing renal failure, dialysis is medically beneficial and may delay death from uremia for months or even years. In contrast, dialysis will not prevent a rapid death from AIDS, per se, and thus may be futile. While there may be competing interests regarding the survival of AIDS patients in renal failure versus risks to HCWs, current information does not support restricting the health care of AIDS patients on such grounds. Because AIDS patients are subject to prejudice and associated discriminatory practice and because recognition of the occasional patient with AIDS and renal failure who may survive for months on chronic hemodialysis is presently problematic, caution is necessary in determining and documenting medical futility. The principles of autonomy and beneficence are offered as equal moral principles by which professional behavior may be guided. Impaired competence is a special risk for AIDS patients. It is, therefore, recommended that effort be made to obtain advance directives regarding both instructions for future care and proxy designation. Caution is advised regarding the need to ascertain the authenticity of decisions rendered by sick or terminal patients and their proxies. The moral practice of medicine is a labor intensive process involving thorough knowledge of the patient as a person. Conflicting values must be negotiated in a manner that maximizes benefit according to the patient's own values, and medical care must be justly applied in a nondiscriminatory fashion. Should AIDS patients be dialyzed? Why not? The answer for each patient must be specific and individualized, defensible on moral grounds and well documented.