Chapter

Societal Allocation of Resources for Patients with ESRD

Daniel Callahan

in The Roots of Bioethics

Published in print October 2012 | ISBN: 9780199931378
Published online January 2013 | e-ISBN: 9780199980598 | DOI: http://dx.doi.org/10.1093/acprof:oso/9780199931378.003.0012
Societal Allocation of Resources for Patients with ESRD

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The field of bioethics, many would argue, began with the creation of a committee in Seattle 1960 to decide who would be given access to kidney dialysis when there were not enough of those new machines to go around. Eventually, Congress decided to pay the costs of those who need dialysis, an expensive procedure. That program has constantly expanded over the years, the average age of those needing dialysis keeps rising, and the costs are enormous. No limits have ever been set on paying for the program, although there has been widespread agreement that such limits are necessary. A variety of possible means for setting limits are explored: the use of medical criteria, age, a fixed annual budget for the program, quality-of-life years, and means testing. Each of them faces technical and often political obstacles, and none seems near acceptance. It may well be that only a national financial crisis will create the momentum and underline the obvious need for cost control of dialysis.

Keywords: dialysis; rationing; QALYs; costs; reform

Chapter.  6356 words. 

Subjects: Moral Philosophy

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