In That Case

Necessary Limitation of Medical Treatment, Ageism, or Worse? A Policy Proposal for Limiting Kidney Dialysis Availability Over 75

Michael A. Ashby

You are the head of a government health department. Perhaps inspired by the controversial Atlantic magazine article by Ezekiel Emanuel in late 2014—and facing increasing and unsustainable demand for kidney replacement (dialysis) therapy—a working group commissioned by your minister to examine renal services has produced a report that includes the following recommendations:

• That long-term renal replacement by haemodialysis not be available through the public health system for patients over the age of 75 years if they have established progressive chronic diseases that generated the renal failure (notably vascular disease and diabetes).
• That palliative care alternatives be developed to assist those who do not receive dialysis to have optimal care and support until death.
• That the minister and department of health hold a series of public forums to gauge public opinion and formulate public policy and a transparent procedure for such treatment limitation decisions in the future.

How would you progress this policy towards implementation? Is it ethically defensible? What principles and processes could make it ethically defensible? How would you deal with legal challenges? How would you engage the public and health workers on this issue?

Reference
Emanuel, E.J. 2014. Why I hope to die at 75: An argument that society and families—and you—will be better off if nature takes its course swiftly and promptly. The Atlantic, October. http://www.theatlantic.com/features/archive/2014/09/why-ihope-to-die-at-75/379329/.

Call for Responses

We at the JBI invite and encourage you to respond to the case “Necessary Limitation of Medical Treatment, Ageism, or Worse? A Policy Proposal for Limiting Kidney Dialysis Availability Over 75” (available freely via the link) and share your expertise and experiences.

Responses should be 500–800 words, although longer manuscripts will be considered, and should conform to JBI style (see the Style Guide and/or the JBI Instructions for Bloggers). The editors reserve the right to edit contributions; however, editorial changes will be cleared with authors prior to publication. Responses should be submitted via the “Leave a Reply” commenting feature below. (You also may contact Consulting Editor and In That Case Editor Michael A. Ashby directly.)

Accepted responses will be published here at bioethicalinquiry.com. Additionally, online responses will be collated and summarized in an editorial commentary to be published in both the The JBI Blog and the next print issue. We also will encourage authors of some online posts and selected scholars with expertise in the topic area to write longer responses for the print version of the journal.

Please join the dialogue and debate. We look forward to hearing from you!