Dialysis in the frail elderly - A current ethical problem, an impending ethical crisis

Bjorg Thorsteinsdottir, Keith M. Swetz, Jon C. Tilburt

Research output: Contribution to journalReview articlepeer-review

22 Scopus citations


The current practice of hemodialysis for the frail elderly frequently ignores core bioethical principles. Lack of transparency and shared decision making coupled with financial incentives to treat have resulted in problems of overtreatment near the end of life. Imminent changes in reimbursement for hemodialysis will reverse the financial incentives to favor not treating high-risk patients. In this article, we describe what is empirically known about the approach to hemodialysis today, and how it violates four core ethical principles. We then discuss how the new financial system turns physician and organizational incentives upside down in ways that may exacerbate the ethical dilemmas, but in the opposite direction.

Original languageEnglish (US)
Pages (from-to)1511-1516
Number of pages6
JournalJournal of general internal medicine
Issue number11
StatePublished - Nov 2013


  • Medicare
  • ethics
  • health policy
  • renal disease
  • shared decision making

ASJC Scopus subject areas

  • Internal Medicine


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