title: Ethical issues in dialysis therapy.
abstract: Treatment for end-stage kidney disease is a major economic challenge and a public health concern worldwide. Renal-replacement therapy poses several practical and ethical dilemmas of global relevance for patients, clinicians, and policy makers. These include how to: promote patients' best interests; increase access to dialysis while maintaining procedural and distributive justice; minimise the influence of financial incentives and competing interests; ensure quality of care in service delivery and access to non-dialytic supportive care when needed; minimise the financial burden on patients and health-care system; and protect the interests of vulnerable groups during crisis situations. These issues have received comparatively little attention, and there is scant ethical analysis and guidance available to decision makers. In this Health Policy, we provide an overview of the major ethical issues related to dialysis provision worldwide, identify priorities for further investigation and management, and present preliminary recommendations to guide practice and policy.
authors.affiliation: The George Institute for Global Health, New Delhi, India; University of Oxford, Oxford, UK. Electronic address: vivek.jha@georgeinstitute.ox.ac.uk.
authors.forename: Vivekanand
authors.initials: V
authors.lastname: Jha
authors.affiliation: School of Medicine, Deakin University, Melbourne, VIC, Australia.
authors.forename: Dominique E
authors.initials: DE
authors.lastname: Martin
authors.affiliation: University of Toronto, Toronto, ON, Canada.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Bargman
authors.affiliation: Institute for Applied Clinical Sciences, Keele University, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Davies
authors.affiliation: University of Leicester, Leicester, UK.
authors.forename: John
authors.initials: J
authors.lastname: Feehally
authors.affiliation: Yale University, New Haven, CT, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Finkelstein
authors.affiliation: University of Sydney, Sydney, NSW, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Harris
authors.affiliation: University of Missouri, Columbia, MO, USA.
authors.forename: Madhukar
authors.initials: M
authors.lastname: Misra
authors.affiliation: Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Remuzzi
authors.affiliation: University of British Columbia, Vancouver, BC, Canada.
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
mesh_terms: D003657:Decision Making / Q000941:ethics; D003695:Delivery of Health Care / Q000191:economics / Q000941:ethics; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy; D017410:Practice Guidelines as Topic / Q000592:standards; D011634:Public Health; D011787:Quality of Health Care / Q000592:standards; D006435:Renal Dialysis / Q000941:ethics*; D017582:Renal Replacement Therapy / Q000941:ethics*