Geriatric Nephrology and Urology

, Volume 2, Issue 2, pp 109–117 | Cite as

Withholding and withdrawing dialysis from elderly ESRD patients: Part 1—A historical view of the clinical experience

  • L.S. Rothenberg
Review article


A review in Part 1 (utilizing US, Canadian and European sources) of the historical and current practices of using age as a selection criterion for dialysis patients demonstrates different national policies and practices. The medical and psychosocial data regarding elderly dialysis patients yield mixed conclusions, but suggest much more positive patient experiences than are generally acknowledged. Part 2 of this paper presents a range of ethical arguments about rationing dialysis therapy for the elderly as a matter of governmental or helath care system policy, based on various ethical principles and notions of “distributive justice.” The seeming greater ethical consensus for not using age per se as a criterion for individual treatment decisions is not reflected in current clinical practice. Finally, discontinuing dialysis has been supported on ethical grounds, and the overall practice of caring for elderly dialysis patients can be facilitated by careful decisionmaking procedures and the provision of appropriate emotional support for patients, families and caregivers, also discussed in Part 2.

Key words

ethics medical kidney failure chronic therapy hemodialysis attitude of health personnel health care rationing aged treatment refusal life support care 


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Copyright information

© Kluwer Academic Publishers 1992

Authors and Affiliations

  • L.S. Rothenberg
    • 1
  1. 1.Division of Medical Genetics, Department of MedicineUCLA School of MedicineLos AngelesUSA

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