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The Hang Up.

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    Patients with end-stage renal disease (ESRD) who miss hemodialysis and use emergency services pose ethical dilemmas. The pandemic may exacerbate biases against non-adherent patients, questioning their right to healthcare.

    Keywords:
    Covid-19clinical ethicsduty to careethics consultationpatient noncompliancescarce resources

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    Area of Science:

    • Medical Ethics
    • Nephrology
    • Public Health

    Background:

    • The ethics service frequently consults on patients with end-stage renal disease (ESRD) utilizing emergency departments (EDs) for dialysis.
    • These patients either miss outpatient hemodialysis or have been discharged from such facilities, making the ED their primary recourse.
    • Consultations often arise due to disruptive behavior post-ICU admission, despite implemented behavior plans.

    Purpose of the Study:

    • To explore the ethical implications of emergency department utilization by non-adherent hemodialysis patients.
    • To examine how the COVID-19 pandemic may influence perceptions of healthcare deservingness based on patient adherence.

    Main Methods:

    • Case consultation review by an ethics service.
    • Analysis of patient scenarios involving end-stage renal disease (ESRD) and emergency department (ED) use.
    • Qualitative reflection on the impact of the COVID-19 pandemic on healthcare access and ethical considerations.

    Main Results:

    • A specific case highlighted a patient with ESRD, cocaine use, and missed hemodialysis, presenting a novel ethical challenge.
    • The scarcity of resources during the coronavirus pandemic intensified concerns regarding ICU bed allocation for such patients.
    • The pandemic may foster a resurgence of judgmental attitudes towards healthcare access based on patient compliance.

    Conclusions:

    • The pandemic's resource scarcity may amplify ethical concerns regarding non-adherent patients' access to critical care.
    • There is a risk of a growing perception that healthcare is a privilege earned through compliant behavior, not a right.
    • This perspective shift poses a significant ethical challenge to equitable healthcare delivery, particularly for vulnerable populations.