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Once dialysis treatment, in 1960, permitted life prolongation for some but not all patients in kidney failure, an `ethical genie' was released. The introduction of peritoneal dialysis and kidney transplantation compounded the physician's dilemma by underscoring those left untreated. Who should be selected for uremia therapy? Should exclusion from treatment be properly delegated to administrators or physicians, or better left to a committee? Are some candidates more worthy than others? As examples: Do Presidents and Kings warrant priority in cadaver organ allocation over ordinary citizens? Are rich people more deserving than the poor? Is it ethical to choose a younger over an older patient? Can children and/or mentally incompetent persons serve as living organ donors? Is it proper to market organs under controlled circumstances?
Eli A. Friedman, an experienced nephrology training program director, and Medical Advisor to the American Association of Kidney Patients, has collected 24 difficult cases that focus on these and other vexing though common stressful issues faced by those who manage kidney patients. Using a novel approach to each case, the opinions of lawyers, nephrologists, patients, and a transplant surgeon are proffered sequentially. Friedman asks and then answers searching questions arising from the debate. The quality of information presented is positively flavored by the fact that three of the respondents (one an attorney) are kidney transplant recipients.
Members of the kidney team, those immersed in seeking truth in medical ethics, and all participating in exploring the legality or ethical basis of organ replacement will find this book pertinent to their effort.
Inhaltsverzeichnis
Case 1 : Withdrawal from Dialytic Therapy.- Case 2: Failure to Understand Dialytic Therapy.- Case 3: Disruptive Patient.- Case 4: Active Heroin Abuse.- Case 5: No Dialysis for Aids Nephropathy.- Case 6: Futile Dialysis.- Case 7: Physician Bias.- Case 8: Self Referral of Dialysis Patients.- Case 9: Game Playing Families.- Case 10: Physician Refusal of Hiv+ Patients.- Case 11 : Religious Control of Patient.- Case 12: Emotionally Related Organ Donation.- Case 13: Discrimination in Organ Donation.- Case 14: "Gift" for Transplant Priority.- Case 15: Child to Parent Kidney.- Case 16: Purchased Kidney.- Case 17: Suspected Subterfuge in Proposing Kidney Donor.- Case 18: Accepting Organ from Mentally Deficient Donor.- Case 19: Consent from Child for Organ Donation.- Case 20: Donor Kidney Allocation to High Risk Patient.- Case 21: Politician's Priority for Cadaver Donor Kidneys.- Case 22: Cadaver Donor Kidney for Non-Compliant Dialysis Patient.- Case 23: Organ Donation/Acceptance by Orthodox Jews.- Case 24: Hopeless Prognosis.- Editor's Remarks.- Editor's Epilogue.- References.
