Ethics Grand Rounds - "The Dialysis Default Is Increasingly Problematic for Older Patients with Renal Failure"

"The Dialysis Default Is Increasingly Problematic for Older Patients with Renal Failure"

Speaker

Alvin H. Moss, M.D., FACP, FAAHPM
Professor of Internal Medicine in Nephrology and Geriatrics,
Palliative Medicine and Hospice
Director of the Center for Health Ethics and Law
Robert C. Byrd Health Sciences Center of West Virginia University

Abstract: 

Many older adults with kidney failure and comorbidities may not live any longer with dialysis than without it. However, the de facto default practice is to start dialysis in most patients with progressive stage 5 chronic kidney disease. Medical anthropologists have described two factors contributing to the dialysis default: changing societal expectations resulting in a “biomedicalization of aging” and a “technological imperative” reflected in the difficulty of saying “no” to life-extending interventions, regardless of age, frailty, and complicating, debilitating medical conditions. Commentators have noted that default options are powerful and may be harmful to some patients. They have emphasized that to counter the clinical momentum of default options; it is necessary for clinicians to engage such patients and their families intentionally and explicitly in the process of shared decision-making. This lecture will present the evidence for the dialysis default and a patient-centered approach to respond to it.

This activity has been approved for AMA PRA Category 1 Credit(s)™ in Medical Ethics and/or Professional Responsibility.

CNE: UT Southwestern is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. This activity will award one (1) contact hour.

Contact: 
Ruth Vinciguerra | Email

This lecture will be presented live via Zoom.