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Patient selection committees: should they be reinstituted?

C A Price, M F Hartigan

ANNA Journal

|October 1, 1993

Summary

End-stage renal disease (ESRD) treatments are now widely available, but ethical debates persist regarding patient selection criteria. This article examines the pros and cons of established protocols for accessing ESRD services.

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Area of Science:

Nephrology
Medical Ethics
Healthcare Policy

Background:

Chronic renal failure management has advanced significantly, with government funding and technology enabling life prolongation.
These advancements have spurred ethical debates concerning quality of life, prognosis, and patient selection for renal replacement therapies.
Historical precedents, like "Death or God Committees," highlight the long-standing challenges in allocating dialysis access.

Purpose of the Study:

To revisit and analyze the critical issue of patient selection criteria for end-stage renal disease (ESRD) services.
To explore the advantages and disadvantages of employing established protocols in accessing ESRD programs.
To contribute to the ongoing discourse within the nephrology community regarding equitable treatment allocation.

Main Methods:

Review and critical analysis of existing selection criteria and decision-making protocols for ESRD.
Examination of ethical considerations, quality of life, rehabilitation statistics, and functional status data.
Discussion of the historical context and evolution of access to renal replacement therapies.

Main Results:

Established protocols for accessing ESRD services present both benefits and drawbacks.
The debate over selection criteria involves complex considerations of medical necessity, patient well-being, and resource allocation.
There is a recognized need for transparent and ethically sound decision-making frameworks in nephrology.

Conclusions:

The prolongation of life for patients with renal failure necessitates careful ethical deliberation regarding treatment access.
Established protocols can offer structure but require continuous evaluation to ensure fairness and efficacy.
Further dialogue is essential to refine selection criteria and improve patient outcomes in end-stage renal disease care.

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