Andrea

Andrea is a fifteen-year-old patient recently diagnosed with reflux nephropathy, a condition where the kidneys are damaged by the backwards flow of urine into the kidneys.  Over time the kidneys can be scarred and damaged.  With her recent diagnosis, the medical team recommended that she be placed on dialysis, while a donor kidney was found.   However, Andrea and her family are part of a religious sect, Shinto, which does not believe in organ transplantation.  Shinto, a Japanese religion, states they want to keep their bodies pure for God, and do not want impure substances entering their bodies, including other people’s organs.   Andrea’s parent’s, Joel and Carol, state that they have done their research and believe that Andrea could beat the renal disease with a healthy diet, drinking ionized water, and taking herbal supplements.  This treatment plan was formed with help of the family’s pastor, who supports the idea of dialysis as well, but does not condone the idea of a possible transplant, even if the transplant was from a family member. 

            Dr. Wilson, her nephrologist, suggests that Andrea see a psychiatrist to determine whether she understands the treatment options presented to her by the care team and her pastor.  The psychiatrist is also supposed to determine if Andrea understands the requirements of dialysis.  The psychiatrist tells Dr. Wilson, that Andrea understands the burdens and benefits of dialysis, and comprehends that she would be on dialysis the rest of her life, if she did not get a transplant.  Andrea states that she would prefer if she could just “go home” with hospice, stating “It’s all right if I die, I’m not scared of death, I get to go home to God.  I’m just afraid my pastor, and parents would feel that I am just giving up.”  Her parents argue that going home and dying is against their beliefs, and that they could not possibly think of a life without Andrea.  Joel and Carol state that Andrea needs to start dialysis, because she can still have a life with dialysis, even if most of her life would be hooked up to a machine.  Dr. Wilson is torn, while is primary responsibility is to his patient Andrea, he does not know if he can go against her wishes and subject her to years of renal dialysis, which might cause her years of suffering.  Should Dr. Wilson place Andrea on dialysis?

-Written by Amanda Zinger