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• W1589738137 abstract "Ms. Bach is a thirty-eight-year-old professional artist with diabetes and end stage renal disease. She has been on dialysis for a little over a year and is on a waiting list to receive a cadaveric kidney, but transplantation is not likely for at least three years. No family member or friend has volunteered as a living donor. Although she tolerates dialysis quite well, she says it causes her such psychological distress that it may drive her to commit suicide. In an outpatient appointment with a consultation-liaison psychiatrist, she complains of severe insomnia and exhaustion. She looks desperate and worn. After a year on dialysis, she says, she is a nervous wreck, unable to concentrate, and above all, unable to work. She is just running from appointment to appointment for her dialysis, recording every sip of water, trying to keep in charge of everything. She feels overwhelmed, empty, without any creative impulse. And without creative activity, she states with determination, she does not want to live. If she cannot paint, there is nothing left but to grieve. Ms. Bach is single and has not had a stable relationship since her divorce several years ago. Both of her parents died the previous year and she is estranged from her brother. In the summer, when her friends are away on holiday, she sometimes does not speak to anyone for weeks. In bleak moments she thinks of her younger sister, who was also diabetic and who killed herself with an insulin overdose in her early twenties. Ms. Bach has just been through a year of therapy for depression. She received outpatient psychotherapy and medication, and she describes the treatment as somewhat helpful, but not particularly. When offered continued psychiatric treatment, she gets upset. She wants a kidney. She has heard that people for whom dialysis does not work can get status on the waiting list. But whenever she asks whether her psychological troubles and her tormenting inability to work do not justify putting her on urgency, she says, her physicians treat her very coldly and say they will not let her blackmail them. According to what her doctors tell her, this center can place only two patients a year on urgency, and those spots are reserved for people whose shunts fail, rendering dialysis impossible. But she says that she too cannot continue dialysis any longer. Does she have to kill herself first to prove it? Should the hospital put her on the list? commentary by Nikola Biller-Andorno It is easy to dismiss Ms. Bach's claim and send her to the next available psychiatrist. That seems to have been the reaction of her nephrologists. But doesn't she have a point when she claims that her psychological suffering should count for as much as somebody else's physical suffering? Of course the high urgency status on the waiting list for a cadaveric organ is not based solely on the suffering caused by dialysis. An even more important consideration is whether a kidney transplant is the only means available to secure the patient's survival. If there are no functioning shunts for hemodialysis, and the patient is not eligible for other dialysis techniques, then life indeed depends on a kidney transplant. Yet Ms. Bach claims that she, too, has no alternative. She has tried psychological treatment, and it has not helped. Her alternative to a kidney transplant is not continued dialysis, she says, but suicide. Certainly Ms. Bach's suffering has to be taken seriously. There is no doubt that her current depression, her chronic illness, her social isolation, and her family history put her on risk for suicide. Also, it would be wrong to blame Ms. Bach for trying to force her way to status. It is tempting but mistaken to reproach her for immoral behavior, greedily trying to snatch a precious space from genuinely suffering patients. Are her prospects as bleak as she sees them? …" @default.
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• W1589738137 date "2001-03-01" @default.
• W1589738137 modified "2023-09-26" @default.
• W1589738137 title "Case Study: An Extremely Urgent Transplantation?" @default.
• W1589738137 doi "https://doi.org/10.2307/3528497" @default.
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