Dialysis and the Undocumented Immigrant


JR is a 32 year old male, who came into the US illegally from El Salvador in search of work. Unfortunately, he also had a serious health problem. He presents to the Emergency Department (ED) of a Catholic tertiary care hospital in the South, with symptoms of renal failure. Initially, the attending ED physician judges that JR may die if not stabilized. A social worker interviews him and discovers that JR has no insurance, very little money for his medical care, and no family in the US.

In addition to the fact that he is working locally as an undocumented immigrant in the construction industry, the social worker also discovers that JR knew he suffered from chronic kidney failure well before he left El Salvador. Moreover, he had had access to treatment there, although he had to travel three hours from home to facility. JR came to the US to improve his standard of living. Assuming he does not receive a transplant, he will need outpatient hemodialysis three times a week for the rest of his life at a cost of approximately $100,000 a year with a normal life expectancy of ten years.

Meanwhile, the ED physician contacts the on-call nephrologist to admit JR. However, the on-call nephrologist arrives, examines JR, and merely prescribes some medication. He advises the ED physician to send him home, arguing that the patient does not need dialysis at this time. The ED physician begins to question the nephrologist who then motions him to the side; however, you overhear the conversation between the two physicians.

The nephrologist becomes agitated and says this habit of treating illegal aliens has got stop somewhere. He claims that it is unethical to give scarce medical resources to illegal aliens when we don’t have enough for our own indigent citizens. Furthermore, he reminds the ED physician that that the medical center is currently paying outpatient dialysis service to dialyze two other undocumented immigrants in similar medical circumstances at a cost of approximately $200,000 a year. He points out that the hospital cannot keep absorbing such costs and suggests that administration will back him up. The ED physician agrees to discharge the patient as recommended.

Cast Study Analysis: 8-Step Model for Ethical Decision Making

The case presented above involving JR and his medical needs doesposeme with an ethical dilemma.To answer the question of best action regarding this case, I will analyze the all the pertinent information presented in the case using the 8-Step Model of Ethical Decision Making (Bennett-Woods, 2001) to identify the facts of the case and any additional information needed to state the real-worldethical problem, establishthe most importantethical question(s), identify the theoretical basis for my analysis, present arguments and counterarguments, brainstorm possibilities for action, and choosemy final action accompanied by the justification of why this option is best for the dilemma in question.

Step 1: Gather Relevant Information

Clinical Indications:

  • 32-year-old man who is presenting symptoms of renal failure
  • Prognosis without treatment, transplant or weekly dialysis, is poor
  • Minorities in the United States are almost two to four times more likely than non-minorities to reach end-stage renal disease or ESRD (Norris MD, 2004)
  • 26 million American adults have CKD and millions of others are at increased risk including minorities such as African Americans, Hispanics, Pacific Islanders, Native Americans and Seniors(National Kidney Foundation, 2010)
  • As kidney disease worsens, the chance of heart disease or ESRD is higher.(Norris MD, 2004)
  • Being diagnosed with any chronic illness including chronic kidney disease (CKD) can cause depression. Depression is the leading cause of disability in the United States and now in the world. (Campbell, 2010)

Patient preferences:

  • JR comes to the United States in search of better living standards
  • He entirely prefers to have his health prpblems addressed through being adminstered with appropriate medical services
  • JR wishes to have a permanent kidney transplant so as to be able to work without disturbances of going to hospitals always
  • JR does not want to go to his home place utreated since he does not have a potential family to support his medaical care
  • JR would like to receive all the medical services concerning his health status to enhance him work and improve his living standards
  • He does not want to leave the hospital untreated since he believes it is in the public hospital where he can be treated free of charge
  • JR does not want to lose his job because of being ill of the cronoc urinary infection

Source by Alice