| Titre : | The value of "life at any cost" : Talk about stopping kidney dialysis. (2007) |
| Auteurs : | RUSS (Ann-J) : USA. Department of Psychiatry. University of Rochester Medical Center. ; Sharon-R KAUFMAN ; Janet-K SHIM ; University of California. Institute for Health and Aging. San Francisco. USA |
| Type de document : | Article |
| Dans : | Social science and medicine (vol. 64, n° 11, 2007) |
| Pagination : | 2236-2247 |
| Langues: | Anglais |
| Mots-clés : | Hémodialyse ; Coût ; Economie santé ; Etats Unis ; Amérique ; Ethique ; Personne âgée ; Homme ; Technologie ; Appareil épuration extrarénale ; Amérique du Nord ; Accompagnement mourant |
| Résumé : | [BDSP. Notice produite par INIST-CNRS qgR0x5Xb. Diffusion soumise à autorisation]. With the trend toward an older, sicker dialysis population in the USA, discussions of ethical issues surrounding dialysis have shifted from concerns about access to and availability of the therapy, to growing unease about non-initiation and treatment discontinuation. Recent studies report treatment withdrawal as the leading cause of death among elderly dialysis patients. Yet, the actual activities that move patients toward stopping treatment often remain obscure, even to clinicians and patients themselves. This paper explores that paradox, drawing on anthropological research among patients over age 70, their families, and clinicians in two California renal dialysis units. It concludes that many older patients sacrifice a sense of choice about dialysis in the present to maintain "choice" as both value and possibility for the future. Even so, patients desire more information and communication, provided earlier in their illness, about prognosis, how long they can expect to be on dialysis, and what the impact of the treatment will be on their daily lives. That, with time, there is a transition to be made from dialysis as "treatment" to end of life care could be better explained and managed to alleviate patients'confusion and unneeded isolation. |
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