The Courage to Fail by Judith P. Swazey

Author:Judith P. Swazey [Swazey, Judith P.]
Language: eng
Format: epub
Tags: Social Science, Sociology, General, Disease & Health Issues
ISBN: 9781351484381
Google: 7tszDwAAQBAJ
Barnesnoble:
Goodreads: 1198635
Publisher: Routledge
Published: 2001-03-31T00:00:00+00:00

8

Patient Selection and the Right to Die: Problems Facing Seattle’s Kidney Center

From its inception in 1961-62, the most controversial and publicized feature of Seattle's chronic dialysis program quickly became its Admissions and Policy Committee. This board of laymen and physicians was appointed to formulate and use nonmedical criteria for deciding who among the medically qualified candidates approved by the center's Medical Advisory Committee would receive one of .the limited number of kidney machines available. The decision to form the admissions committee was also prompted by a desire to "protect those in charge of the Center from pressure to take a given patient" (Murray et al. 1967, p. 316). A third function, more difficult to fulfill since the committee members wished to remain anonymous, was to have the committee "represent the Center in the community." "The future of tie Center," its founders wrote in I962, "rests, in large part, on assessment of its acceptability as a community service by this group" (Murray et al. 1967, p. 316).

National attention was drawn to the Seattle center's program, particularly to the workings of the admissions committee, through an article by Shana Alexander that appeared in Life magazine in November 1962. Colorfully but accurately entitled "They Decide Who Lives, Who Dies: Medical Miracle Puts Moral Burden on a Small Committee," the story captured the inherently dramatic nature of the artificial kidney program: the frankly experimental nature of chronic dialysis; the dependence of the patient upon the workings of a machine—the fact that for the rest of his life he must "surrender his life's blood to a medical laundromat twice a week"; and, above all, the radically unorthodox step of involving laymen in making life-or-death decisions about a candidate's acceptability for this medical procedure.

"As I recall that period," Belding Scribner wrote in 1972, all of us who were involved felt that we had found a fairly reasonable and simple solution to an impossibly difficult problem by letting a committee of responsible members of the community choose which patients [would receive treatment] among several who were medically ideal . . . through pre-screening by the Medical Selection Committee. In retrospect, of course, we were terribly naive. We did not realize even then the full impact that the existence of this committee would have on the world. [We] simply could not understand why everyone was much more interested in the existence and operation of the lay selection committee than in the fact that in two years we had taken a disease, end-stage kidney disease, and converted it from a one hundred percent fatal prognosis to a ninety-five percent two year survival. Nor were any of us prepared for the very severe criticism that was to be forthcoming both at the annual medical meetings and in the scholarly literature. [Scribner 1972, p. 5]

Although patient selection has been the most visible and therefore most discussed issue posed by the limited availability of chronic dialysis, it is by no means the only socially and ethically troublesome matter that this procedure has paradigmatically raised.

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