Ethical Issues in Hemodialysis

The history of hemodialysis is closely intertwined with the birth of bioethics. In 1960, Belding Scribner’s invention of the arteriovenous shunt offered hope for continuing life for the population with end-stage renal disease that had formerly faced a certain death. Suddenly, there were many patients and limited resources with which to serve them, giving rise to profound ethical questions: who should have access to these resources? How should candidates be selected and by what criteria? This chapter provides a discussion of the ethical quandaries that emerged in establishing continuing treatment for patients with chronic renal failure. The author was privileged to know Dr. Scribner and some of his associates such as Dr. Christopher Blagg, as well as Dr. George Aagaard, former dean of the Medical School, and Dr. John Hogness, former president of the University of Washington. These relationships allowed personal communications regarding ethical issues arising from the newly developed practice of chronic renal dialysis.