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The value of "life at any cost": Talk about stopping kidney dialysis

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  • Russ, Ann J.
  • Shim, Janet K.
  • Kaufman, Sharon R.

Abstract

With the trend toward an older, sicker dialysis population in the USA, discussions of ethical issues surrounding dialysis have shifted from concerns about access to and availability of the therapy, to growing unease about non-initiation and treatment discontinuation. Recent studies report treatment withdrawal as the leading cause of death among elderly dialysis patients. Yet, the actual activities that move patients toward stopping treatment often remain obscure, even to clinicians and patients themselves. This paper explores that paradox, drawing on anthropological research among patients over age 70, their families, and clinicians in two California renal dialysis units. It concludes that many older patients sacrifice a sense of choice about dialysis in the present to maintain "choice" as both value and possibility for the future. Even so, patients desire more information and communication, provided earlier in their illness, about prognosis, how long they can expect to be on dialysis, and what the impact of the treatment will be on their daily lives. That, with time, there is a transition to be made from dialysis as "treatment" to end of life care could be better explained and managed to alleviate patients' confusion and unneeded isolation.

Suggested Citation

  • Russ, Ann J. & Shim, Janet K. & Kaufman, Sharon R., 2007. "The value of "life at any cost": Talk about stopping kidney dialysis," Social Science & Medicine, Elsevier, vol. 64(11), pages 2236-2247, June.
    • Handle: RePEc:eee:socmed:v:64:y:2007:i:11:p:2236-2247
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    References listed on IDEAS

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    1. Stanton, Jennifer, 1999. "The cost of living: kidney dialysis, rationing and health economics in Britain, 1965-1996," Social Science & Medicine, Elsevier, vol. 49(9), pages 1169-1182, November.
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    Cited by:

    1. Llewellyn, Henry & Low, Joe & Smith, Glenn & Hopkins, Katherine & Burns, Aine & Jones, Louise, 2014. "Narratives of continuity among older people with late stage chronic kidney disease who decline dialysis," Social Science & Medicine, Elsevier, vol. 114(C), pages 49-56.

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