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J Gen Intern Med. 2013 Nov;28(11):1511-6. doi: 10.1007/s11606-013-2494-1. Epub 2013 May 18.

Dialysis in the frail elderly--a current ethical problem, an impending ethical crisis.

Author information

1
Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA, thorsteinsdottir.bjorg@mayo.edu.

Abstract

The current practice of hemodialysis for the frail elderly frequently ignores core bioethical principles. Lack of transparency and shared decision making coupled with financial incentives to treat have resulted in problems of overtreatment near the end of life. Imminent changes in reimbursement for hemodialysis will reverse the financial incentives to favor not treating high-risk patients. In this article, we describe what is empirically known about the approach to hemodialysis today, and how it violates four core ethical principles. We then discuss how the new financial system turns physician and organizational incentives upside down in ways that may exacerbate the ethical dilemmas, but in the opposite direction.

PMID:
23686511
PMCID:
PMC3797329
DOI:
10.1007/s11606-013-2494-1
[Indexed for MEDLINE]
Free PMC Article

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