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Post ethics and dialysis
Author: hstuch
Date: Aug 11, 2011 6:40 am
At huge financial loss, our hospital has offered dialysis to a small population of uninsured patients, sometimes for many years. The current fiscal crisis has led to a decision to stop this service. Patients will be dialysed in the hospital as needed, will be helped to find any available support upon discharge but will no longer be able to return for routine dialysis.
The palliative care service has been asked to see these patients, advise about goals and address symptoms. The patients want to continue dialysis and view our discussion as coercive. We want to help the patient and families but are conflicted about the use our service should be used this way. Anyone have any insights?
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Re:ethics and dialysis (by itriana on 08/12/2011)
Considering the fact the pts know that the services has been stopped due to out of control financial circumnstances it has to be carefully handled. To accomplish your goals you should focus on specific situations. Focus on reassurance and provide them with all community resources availables as possible. S.W to look for new opportunities for help. Reapplications of Medicaid or any other type of medical help available. Maybe some that covers dialysis only. Never mentioned the end of life care at this point since as per your comment I'm assuming that most, are still getting benefits from the treatment or at least their goal of care was to continue with them. Hope this help
Re:ethics and dialysis (by Leisa_Greathouse on 08/12/2011)
Is there a grant that would fund you to continue this service? Are there other programs in the area offering dialysis at no charge, such as a Care Clinic, Health Dept.? What about medicare or medicaid, or SS, (as if these organizations aren't already maxed out).
+ Re:ethics and dialysis (by hstuch on 08/13/2011)
Thanks to all who responded to this post. We of course will look for all available resources in our community for these patients. But will be left with a small but sig population who will die because they will not receive dialysis as outpatients. Is this situation different than that of a patient being denied a transplant because they lack finances? (we have no problem seeing those patients on consult) Should we on principle say that we should not see these patients because we are being used as a means of offering "something" however poorly matched to their goals?

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