Doctors distressed by ‘unethical’ dialysis rules for undocumented immigrants

According to recent research, medical doctors in many of the US states that don’t cover services for undocumented immigrants until they are in a near death situation feel they are in a moral dilemma considering they took an oath to ‘do no harm’ but the dialysis payment policies are not exactly supportive of the oath.

It is estimated that approximately 6,500 of the end-stage kidney disease cases in the United States are suffered by undocumented immigrants but because they are undocumented, they cannot get the required dialysis treatment needed to stay alive because of the policies that only support treatment when it becomes an emergency. The Annals of Internal Medicine reported this.

Apart from the obvious medical implication of allowing the condition to deteriorate in these undocumented immigrant patients and the increased cost of treatment, the author pointed out that doctors are being made to go through an impossible ethical position as well as building up job dissatisfaction and burnout.

Dr. Lilia Cervantes of Denver health and the University of Colorado School of Medicine who happened to be the lead author noted that the undocumented immigrants that have to depend on emergency-only hemodialysis are critically ill and close to death and as a result, they have to form a relationship with the patients and their relatives. She went on to note that the friendship means that they get invited to weddings and other family events of the patients but the sad thing is that they also get invited to their funerals.

There is a 14-fold higher chance of death in patients who have ESKD and have to wait till it becomes an emergency; as compared to those who routinely receive their dialysis treatment. Also, the Emergency dialysis costs at least 4 times what the routine dialysis costs. Cervantes also stated that it is emotionally draining as a medical practitioner to have to watch people go through needless suffering.

The kidney is supposed to filter the blood and get rid of excess fluid and toxins from the body as urine and the entire body depends on the kidney to do this effectively. If the kidney fails to do this, the body may still be able to carry on for days, or at most a few weeks until they start getting dialysis treatment or a transplant from a donor.

Hemodialysis is the process by which the blood is filtered for 4 hours and ought to be done 3 times in a week to effectively rid the body of toxins and excess fluids. Medical insurance providers like Medicaid and Medicare do not cover dialysis of the undocumented immigrants, except in cases where the individual state decides to set some funds aside to pay for treatment.

Cervantes said that patients who qualify for this emergency dialysis are those that arrive in the hospital short of breath or complaining of a somewhat drowning sensation, which arises from the saturation of so much fluid in the body. They may suffer from conditions like confusion, nausea, vomiting and in some cases, they might need Cardiopulmonary resuscitation (CPR) because of the unusual heart rhythm.

Fifty clinicians, including nurses and doctors were used for this survey and the focus was on how providing emergency-only dialysis impacted the profession and feeling about the profession.

The health care providers and medical experts noted that it was exhausting to have to deal daily with organizational and system-level barriers to treating patients. The avoidable sufferings and death of patients is another issue they pointed out as worrisome.

There was also the issue of providing substandard care to patients just because they are tagged as “undocumented immigrants.” The payment policies make it impossible to provide all patients with top quality medical care.

This study shows categorically the impact that the denial of dialysis to patients on the basis of their immigration status is having on them morally and ethically. This is the first study that focuses on the impact of emergency-only dialysis policy – that the US has on undocumented immigrants – on the medical practitioners. It is expected that the emergency-only policy is bad for patients however; this study reveals the impact it has on the healthcare providers as well; a perspective that most people won’t really spend much time to consider.

As we’ve stated before in articles about nephrologist burnout, job dissatisfaction is a very big problem when it comes to kidney doctors and burn-out for them often leads to a lowered quality of care for the patients, so in the end, this move is a double blow to the most important people, the patients whose lives are at stake.

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