BHP: ETHICAL ISSUE IN DIALYSIS

Goals
The hemodialysis procedures targeted at removing both low- and high- molecular
weight solute from blood.

Principle
Relies on principle of solute diffusion on semipermeable membrane.
Movement of metabolic waste products takes place down a concentration
gradient from the circulation into the dialysate. There are 3 essential
components of hemodialysis:
1. Dialyzer: a plastic a plastic chamber with the ability to perfuse blood and
dialysate compartments simultaneously at very high flow rates. These
dialyzers are composed of bundles of capillary tubes through which blood
circulates while dialysate travels on the outside of the fiber bundle.
2. The composition and delivery of the dialysate*
Dialysate: fluid and solute in dialysis process that being discarded
3. The blood delivery system: composed of the extracorporeal circuit in the
dialysis machine and the dialysis access. The dialysis machine consists of
a blood pump, dialysis solution delivery system, and various safety
monitors. The blood pump moves blood from the access site, through the
dialyzer, and back to the patient

Complications: hypotension, muscle cramp, anaphylactoid reactions to the
dialyzer particularly on
its first use.

Cost: almost $88,000 for hemodialysis, a treatment for kidney failure that filters
blood outside the body.

prognosis. and. overall medical condition. 1. Moss AH. and most people need financial help.nih. the burdens of treatment substantially outweigh the benefits. patients' best interests. to follow state law and formulate decisions with patients' appropriate legal agents that respect patients' wishes. 2nd Ed. complication. EXAMINING MEDICAL INDICATION: requires a consideration of the patient's diagnoses. PREFERENCES OF THE PATIENT: based on the patient's own values and personal assessment of benefits and burdens. or. 4. DECISION MAKING: shared decision-making is the recommended model for dialysis decision-making because it addresses the ethical need to fully inform patients about the risks and benefits of treatments.6(9):2313–7. FINANCIAL ISSUE: hemodialysis and peritoneal dialysis—is costly. Ethical principles and processes guiding dialysis decision-making. beneficence.niddk. Harrison’s Nephrology and Acid Base Disorder. nonmaleficence.gov/health-information/health-topics/kidney- disease/financial-help-for-treatment-of-kidney-failure/Pages/facts. are ethically relevant. 2. Page 142-145 3. Resources: 1. Financial help is available from the Federal Government and other sources. “Who has the authority to decide on behalf of this patient?” The patient preferences topic reflects the ethical principle of respect for autonomy because providers of care. Medical indications reflect the ethical principles of beneficence and nonmaleficence because the decisions based on medical indications must be guided by the ethical duty to benefit patients and do them no harm. Professional integrity requires physicians to refrain from providing dialysis when it is not medically indicated. if the wishes are unknown. the following questions must be raised: What are the patient's goals? Has the patient been provided sufficient information? Does the patient comprehend? Is the patient consenting voluntarily? If the patient lacks decision-making capacity. Clin J Am Soc Nephrol. that is. family members.ETHICAL ISSUE This approach uses the ethical principles of respect for patient autonomy. 3. nephrologists must ask. and professional integrity. http://www. and treatment options.aspx . In every clinical case. and others have an ethical duty to accept the decisions regarding medically indicated treatment made by patients with decision-making capacity. justice. 2011. 2. in the absence of capacity. as well as the need to ensure that patients' values and preferences play a prominent role.