The Lack of Effective Care

Kidney failure is often undertreated by doctors. Patients frequently are told to come back for care only when they are in such discomfort that they are ready for dialysis. Numerous articles have been published in medical journals reporting various means to slow the downhill course of kidney disease; even so, most patients never receive these treatments. Untreated kidney failure usually progresses to end-stage renal disease, at which point dialysis or transplantation becomes essential for survival. Every year some 60,000 people start dialysis in the U.S. But many people on dialysis don't feel well. In fact, dialysis is so grueling that, according to the official government report of the U.S. Renal Data System for 1999, "1 in 5 patients withdraws from dialysis before death." In other words, in effect they commit suicide. It should be noted, however, that death by withdrawal from dialysis is usually a "good death," meaning that suffering is minimized. But clearly it is best to avoid dialysis as long as possible.

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