With a growing population of elderly individuals and much debate of health care reform, rationing seems to be a familiar term that gets thrown into the discussion regarding the obvious increased financial impact relative to the country’s responsibility to care for our aging population with multiple health problems. For the purpose of this discussion, I will focus on one of my two specialties, nephrology nursing.
Chronic Kidney Disease is the term we use to describe the body’s reduced ability to filter waste products and toxins from the blood by way of the kidneys. This disease is progressive and pervasive. According to the CDC (2010), more than 10% of people or more than 20 million people aged 20 years or older in the United States have Chronic Kidney Disease. Many medications and therapies are available for the treatment of chronic kidney disease. These options may slow down the progression of kidney disease. However, chronic kidney disease is progressive and may ultimately lead to end-stage renal disease. There are five stages of chronic renal disease. Each stage is categorized by kidney function as evidenced by the glomerular filtration rate. Renal failure is established at stage five in which only two options are available: transplantation or dialysis.
There is no need to mention that transplantation simply isn’t an option for many people. There simply are far less available organs than there are people in need of them. Patients wait on transplantation lists for years and some will meet the end of life before ever receiving a transplant. Therefore, dialysis is the immediate and life-sustaining choice for many patients. However, dialysis is a very expensive treatment modality that requires extensive care and close monitoring. In some countries, some groups of people are simply deemed ineligible for such a treatment option. One such group is the elderly. Craig argues (as cited in Blumenthal, Moon, & Warsharsky, 2003) elderly patients in the United States who receive federally funded dialysis for kidney failure would not receive treatment in Great Britain due to age. He further argues that according to some governments the elderly has higher susceptibility for death and society would not benefit from the use the publically funded dollars to treat them.
Ethical Dimensions There are many ethical dimensions that exist in this case. Patients have the right to be autonomous and