But the law has unintended consequences, kidney experts say. It should be in the middle ages and to keep young people alive and productive. Instead, many of the patients who take advantage of the law are old and other medical problems, often as a replacement for their failed kidneys by dialysis suffer but not for long, because you kill other chronic diseases have life.
Specialists urge kidney doctors more with older people to be frank, others have serious medical conditions, to the patient say that although they have dialysis, they want can decline such treatment and instead give a hospice. In the end, it is always the patient choice.
An idea that is of leading specialists, each change doctors refer to give themselves up the decision on dialysis. Instead of, say, that a patient is deprived of dialysis or not to start agreement say these specialists, that the patient has selected "medical management without dialysis."
"This is the preferred term," said Nancy Armistead, executive Director of the mid-Atlantic renal Coalition, a Medicare contractor that collects data and patient complaints.
The phrase, she says, "acknowledges that death is imminent", but it also sends an important message: "we are not only send people home to die." "We provide palliative care."
A Committee formulated before recently guidelines for use of the Club doctors renal decision if dialysis is appropriate. It contains, the doctors themselves should questions before the treatment proposed. One is the "surprise" question: I would be surprised if this patient dead within a year?
But, turning it over to the Chairman of the Committee, Dr. Alvin H. Moss, a nephrologist and ethics at West Virginia University, which is the task ahead as an ocean liner said.
"Clearly, if the program was initiated in the 1970s, the hope and the expectation was that this program otherwise return would, that healthy people in the society could be back, so that they are working and productive,", said Dr. Manjula Kurella Tamura, Kidney specialist at Stanford. But, she added, "Dialysis at the end of life is a different kind of treatment."
Dialysis is difficult, especially for the old and the sick. Most of the nation spend 400,000 dialysis patients travel many hours, three days a week, connected to a state machine and additional time back and forth to the hospital.
You have to limit salt and fluids, and the procedure is so stressful that some patients for the rest of the day resting. Although dialysis symptoms as fluid accumulation in the legs or lungs can alleviate, can it to dizziness, weakness, carry cramps in the leg, nausea and other problems. Complications such as blood infections or clogged blood vessels, where the dialysis needles are placed, are common, surgery or hospital is often required. Ultimately, as a patient is not ready to go with him in five at.
It can still hard to say no.
An 84-year-old man in a hospital in Elkins, WV, running from West Virginia University handled has been advised against dialysis. He has high blood pressure and severe congestive heart failure, a condition so fatal as terminal cancer. Make his heart problems hard to breathe it for him, and he is often in the hospital. In a telephone interview, the man said he saw suffering friends in dialysis patients and always thought that he would reject it. But he is always ready to start in any case. The man, whose Name to protect of his privacy will be held back, says, that he changed his mind after he "SA and thought over how well live."
"What choice you really have?" he asked.
As Congress the right numbers for kidney patients in October 1972 founded on dialysis and transplantation were new procedures which were not covered by the health insurance companies. There were terrible stories - rich people have dialysis and lived while poor people died. In Seattle a Committee art dialysis by vote over, that it could get. A man who was a family support took, for example, the priority of a single woman.
It was also expected at this time that less than 40 patients per million would have to dialysis, and most of the patients would be healthy - with the exception of their failed kidneys - and under the age of 54.
Now more than 400 people per million start dialysis every year. More than a third of the patients are are 65 or older, and about 42 percent of the cost. People over 75 are the fastest growing group of dialysis patients. And the most older patients have other serious diseases such as diabetes, heart failure, stroke, and even advanced dementia. Do have a third of them four or more chronic diseases.
The federal program, said Dr. Peter S. Aronson, Professor of Nephrology at the Yale University School of medicine "is incorrectly applied so emblematic of good intentions."
"The question," said Dr. Aronson, "is, how it back to choose."
Recent studies have found that dialysis for many older persons with other severe chronic diseases will extend not life. A study found that the procedure of main effect, increase the chances that such patients in the hospital instead of at home die.
Now, costs are float - the nation an estimated $40 billion to 50 billion dollars cost end-stage renal disease this year. And doctors recommend dialysis of earlier studies although later found that an early start gives no added benefit.
Nevertheless, Mrs. Armistead said if select patents "medical management" are ready, often fighting members of the family with the decision.
It can be difficult, to make some patients understand the severity of the disease or its decisions, Barbara Weaner said a nurse practitioner at the West Virginia University, who works with dialysis patients.
"We live in a country where there are a lot of choice, where people tend to fear will die and palliative treatment is not always recognized as a good alternative," said Mrs weaner.
Their show their patients in the Hospital of Elkins. Those, the old and very sick often are to have them can the choice - "medical management" without dialysis or they have dialysis may fail to improve their lives. But for many, the choice is not acceptable.
A patient, whose Name is to be retained, 78-year-old woman was not a good candidate for dialysis, their doctors said. It has complications from diabetes, high blood pressure, heart valve problem and severe coronary heart disease. Their medical problems were so serious that dialysis was probably lead to a series of medical interventions - to extend their life hospitalizations, drugs and doctor visits - but not necessarily would. And her doctors told her that.
But she insisted on dialysis, has to say, "some life better than no life." In the seven months it is, has hospitalized she was four times, including twice for heart surgery patients.
"I go to dialysis, because I want to live," she said in a telephone interview. "I want dialysis."
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