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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 11/2013

01-11-2013 | Perspectives

Dialysis in the Frail Elderly — A Current Ethical Problem, an Impending Ethical Crisis

Authors: Bjorg Thorsteinsdottir, MD, Keith M. Swetz, MD, MA, Jon C. Tilburt, MD, MPH

Published in: Journal of General Internal Medicine | Issue 11/2013

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ABSTRACT

The current practice of hemodialysis for the frail elderly frequently ignores core bioethical principles. Lack of transparency and shared decision making coupled with financial incentives to treat have resulted in problems of overtreatment near the end of life. Imminent changes in reimbursement for hemodialysis will reverse the financial incentives to favor not treating high-risk patients. In this article, we describe what is empirically known about the approach to hemodialysis today, and how it violates four core ethical principles. We then discuss how the new financial system turns physician and organizational incentives upside down in ways that may exacerbate the ethical dilemmas, but in the opposite direction.
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Metadata
Title
Dialysis in the Frail Elderly — A Current Ethical Problem, an Impending Ethical Crisis
Authors
Bjorg Thorsteinsdottir, MD
Keith M. Swetz, MD, MA
Jon C. Tilburt, MD, MPH
Publication date
01-11-2013
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 11/2013
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-013-2494-1

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