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October 30, 1972

The Agony and the Ecstasy Of the Nephrologist

Author Affiliations

St. Luke's Hospital Center New York

JAMA. 1972;222(5):584-585. doi:10.1001/jama.1972.03210050056023

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To the Editor.—  There are no hopeless diseases, only hopeless remedies. This was, is, and will probably always be true in medicine. But what if the remedy is adequate but not readily available? This is the dilemma that the physician taking care of patients with renal disease faces daily.First, the existing dialysis facilities in the United States fall far short of the number of patients requiring dialysis. This has forced many, but not all, dailysis centers to set age guidelines above which they will not seriously consider patients for dialysis. Although home dialysis and out-ofhospital care facilities have allowed some older patients to receive dialysis, only a small fraction of the people above the age of 65 years who require dialysis receive it. The rest are allowed to die. The only justification the physician can give himself for this loss of life is that there are far too many