Angel McDowell and Graham Ellis
Encyclopedia Entry: Dialysis
Definition
Medical dialysis refers to the “clinical purification of blood by dialysis, as a substitute for the normal function of the kidney (English Oxford Living Dictionary).” Formally referred to as hemodialysis and/or renal dialysis, these terms encompass the process in which a patient is connected to a machine that removes toxins and impurities from the bloodstream due to the malfunction of one or both kidneys(Encyclopaedia Britannica).
Chronic Kidney Disease (CKD) describes kidney damage arising from a genetic disposition or the accumulation of negative health behaviors, or internal injury occurring a lifetime. The American Kidney Fund claims that as of 2015, “more than 31 million Americans” are affected by the disease; that is a ratio of more than 1 in 10 individuals living with kidney decay. Nephritis [inflammation of the kidneys], nephrotic syndrome [excessive protein loss in urine, and nephrosis [any form of kidney disease] make up the top 10 leading causes of deaths in American. Furthermore, many people remain unaware of their respective health status (National Center for Health Statistics 2015).
Controversy/Perspectives
The action of dialysis is enveloped in controversy in regards the patient’s decision to make end-of-life decisions. When faced with a patient who is unable to discern the associated risks/benefits of indefinite and routine blood transfusions, a complex dialogue proceeds between healthcare provider and family (or care giver). This decision becomes more complicated as the patient battles co-morbid conditions; thus signifying other life-threatening illnesses are joined with kidney failure. Since CKD is likely to co-exist with conditions such as “cardiovascular disease, diabetes, hyperlipidemia, anemia and metabolic bone disease,” the elderly population is most vulnerable to suffer from the untreated effects of kidney failure and denied renal restoration.
In the 1960’s, the United States government was emphasizing the rationing of materials and social labor due to the costly war in Vietnam. Markets were geared towards the war effort, and most medical attention was directed towards military servicemen returning from war. As a result, little innovation was made towards treating and creating a lasting solution for kidney disease. Resource scarcity had an impact on artificial and donor kidney supply, as it has never satisfied the demand of patients requiring renal replacement. This led to the deaths of many Americans, as little government resources were put towards medical solutions.
The National Institute of Health’s director, James Shannon, publicly recognized the life saving properties of dialysis. Nevertheless, the expensive treatment remained exclusive to those of high socioeconomic status and relative physical health. Director Shannon wrote to the Surgeon General at the time, Luther Terry, to express his understanding of the situation: “lives could be saved, but at a high cost to individuals and the country (Rettig 2011).” In result, the term “death panel” was coined to describe the process of choosing a “family man… in prime working years” to be treated instead of an “elderly patient with coexisting conditions” with lower rehabilitation. Essentially, death panels refer to the choice of saving one life over another by health care professionals or other parties involved. The creation of “Life or Death” committees burdened lawyers, surgeons and other significant stakeholders with the moral decision of identifying those qualified for dialysis treatment (Alexander 1962).
Additionally, the article mentions that racial stereotypes and prejudices play a major role in whether or not a physician takes interest in a patient’s kidney troubles. Black patients were hesitant to speak about this matter to doctors as they felt “less competent than whites… and seldom had access to a [kidney] transplant surgeon (Alexander 1962).” This phenomenon of medical discrimination displays the levels of racialization that were occurring in the medical field. Racialization refers to practice of ascribing racial identification onto an unrelated practice or idea. In this case, the use of dialysis to treat patients was viewed arbitrarily through a racial lens, but race has no effect on its effectiveness. This sort of racialization leads directly to harmful health impacts on minority groups, and in this case, lead to higher rates of kidney diseases amongst African-Americans. Other populations that were being exploited by healthcare providers, dismissed from receiving early kidney disease detection, and confined to inadequate care by not being chosen for dialysis due to social worth include women, immigrants, people of couple, trans* persons, people of low SES, and patients displaying any physical/mental faults.
Historical Context/Politics of Health
After many negotiations between the VA, the Bureau of Budget and the Office of Science and Technology, the United States government founded more CKD focused programs in order to increase the number of patients that can afford care. For a decade, home dialysis was the most common option for patients as it effectively “reduced costs and increased access” for those in need (Rettig 2011). Fortunately, in October of 1972, patients under Medicare that continuously invested money to the system obtained social security health insurance under the Entitlement for End- Stage Renal Disease (ESRD). This highly requested legislation was socially demanded by the increasing occurrence of public demonstrations protesting Medicare, mainstream news publications reporting variable medical access, the increased number of kidney transportation centers with specially trained staff members, nurses, and social workers. Despite the known benefits of dialysis in the early 1960’s and 1970’s, many people were unable to receive treatment for CKD. The unification of various organizations buzzing about the controversy of dialysis access sped up the process for more Americans to receive treatment moving into the 21st century (Rettig 2011). This process of Americans expressing their belonging to the state through their health is a direct tie to the politics of health. Biological citizenship refers to the process of attempting to be recognized and acknowledged by a state or government using bodies and health. The demand for dialysis is an excellent example of this phenomenon; Americans that felt they weren’t being acknowledged by the state pushed for more equitable access to dialysis and achieved recognition through the government’s changing policies.
Today, DaVita is the “leading provider of kidney care in the United States to patients with [CKD] and end stage renal disease (DaVita 2017).” The company operates facilities worldwide in major countries like Brazil, Germany, India, China, and Saudi Arabia. The 2016 Annual Data Report Highlights published by the United States Renal Data System (USRDS) states, “[hemodialysis] exceeded $50 billion, representing 20 percent of all Medicare spending in this age group.” As the number of CKD increases, doctors must speak with patients to determine the best option moving forward as rehabilitation is not always a possibility. Dialysis is a revolutionary medical treatment for kidney failure and one’s remaining life span must not rely on social worth as it had a mere 40 years ago.
References:
Alexander, Shana
1962 Medical miracle and a moral burden of a small committee: They decide who lives, who dies. LIFE November 9 (1962): 102-104, accessed March 11, 2017, https://books.google.com/books/about/LIFE.html?id=qUoEAAAAMBAJ/
DaVita
2017 About DaVita – A leading provider of kidney care, accessed March 12, 2017, https://www.davita.com/about/
Encyclopaedia Britannica, s.v. “Dialysis,” accessed March 10, 2017, https://www.britannica.com/topic/dialysis-hemodialysis/
English Oxford Living Dictionary, s.v. “Dialysis,” accessed March 10, 2017, https://en.oxforddictionaries.com/definition/dialysis/
National Center for Health Statistics
2015 Health United States, 2015 Table 19. U.S. Department of Health & Human Services. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm/ , accessed March 10, 2017.
Rettig, Richard A.
2011 Perspective: Special treatment — The story of Medicare’s ESRD Entitlement. The New England Journal of Medicine 364:596-598
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