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December 1, 1989

The Misfortunes of Others: End-Stage Renal Disease in the United Kingdom

JAMA. 1989;262(21):3064-3065. doi:10.1001/jama.1989.03430210106044

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The scholarly discipline of ethics has in recent years metamorphosed from an arcane branch of academic philosophy and theology into a vibrant and important participant in the daily affairs of the profession of medicine. One of the major driving forces behind this transformation has been the complex of ethical issues that derive from the end-stage renal disease (ESRD) program. This program, with its mélange of medical, economic, technological, and sociological factors, contains most of the ethical issues of high-technology medicine. It highlights questions and dilemmas relating to justice, autonomy, beneficence, rationing, and individual vs societal rights and needs. It is proper and fitting that the treatment of ESRD be evaluated from its ethical and sociological viewpoints.

Thomas Halper gives us such an evaluation. His book is a short, readable, and thoughtful analysis of the ESRD program in Great Britain. It is a compelling one to study, for it is a