BHP: ETHICAL ISSUE IN DIALYSIS

Goals
The hemodialysis procedures targeted at removing both low- and high- molecular
weight solute from blood.

Principle
Relies on principle of solute diffusion on semipermeable membrane.
Movement of metabolic waste products takes place down a concentration
gradient from the circulation into the dialysate. There are 3 essential
components of hemodialysis:
1. Dialyzer: a plastic a plastic chamber with the ability to perfuse blood and
dialysate compartments simultaneously at very high flow rates. These
dialyzers are composed of bundles of capillary tubes through which blood
circulates while dialysate travels on the outside of the fiber bundle.
2. The composition and delivery of the dialysate*
Dialysate: fluid and solute in dialysis process that being discarded
3. The blood delivery system: composed of the extracorporeal circuit in the
dialysis machine and the dialysis access. The dialysis machine consists of
a blood pump, dialysis solution delivery system, and various safety
monitors. The blood pump moves blood from the access site, through the
dialyzer, and back to the patient

Complications: hypotension, muscle cramp, anaphylactoid reactions to the

dialyzer particularly on
its first use.

Cost: almost $88,000 for hemodialysis, a treatment for kidney failure that filters
blood outside the body.
ETHICAL ISSUE
This approach uses the ethical principles of respect for patient autonomy,
beneficence, nonmaleficence, justice, and professional integrity.

1. EXAMINING MEDICAL INDICATION: requires a consideration of the

patient's diagnoses, overall medical condition, complication,
prognosis, and treatment options. Medical indications reflect the
ethical principles of beneficence and nonmaleficence because the
decisions based on medical indications must be guided by the ethical duty
to benefit patients and do them no harm. Professional integrity requires
physicians to refrain from providing dialysis when it is not medically
indicated, that is, the burdens of treatment substantially outweigh the
benefits.
2. DECISION MAKING: shared decision-making is the recommended
model for dialysis decision-making because it addresses the ethical need
to fully inform patients about the risks and benefits of treatments, as
well as the need to ensure that patients' values and preferences play a
prominent role.
3. PREFERENCES OF THE PATIENT: based on the patient's own values and
personal assessment of benefits and burdens, are ethically relevant. In
every clinical case, the following questions must be raised: What are the
patient's goals? Has the patient been provided sufficient information?
Does the patient comprehend? Is the patient consenting voluntarily? If the
patient lacks decision-making capacity, nephrologists must ask, Who has
the authority to decide on behalf of this patient? The patient preferences
topic reflects the ethical principle of respect for autonomy because
providers of care, family members, and others have an ethical duty to
accept the decisions regarding medically indicated treatment made by
patients with decision-making capacity, and, in the absence of capacity, to
follow state law and formulate decisions with patients' appropriate legal
agents that respect patients' wishes, or, if the wishes are unknown,
patients' best interests.
4. FINANCIAL ISSUE: hemodialysis and peritoneal dialysisis costly, and
most people need financial help. Financial help is available from the
Federal Government and other sources.

Resources:

1. Moss AH. Ethical principles and processes guiding dialysis decision-making.

Clin J Am Soc Nephrol. 2011;6(9):23137.

2. Harrisons Nephrology and Acid Base Disorder, 2nd Ed. Page 142-145

3. http://www.niddk.nih.gov/health-information/health-topics/kidney-
disease/financial-help-for-treatment-of-kidney-failure/Pages/facts.aspx