You bring up a very good point and so does the story (2 different points). Patients might be willing to take "the natural course of things" but family will many times not understand how someone would not do dialysis if it can keep them living. Family also needs to be counseled when it comes time for an 80+ person to go on dialysis. People can make informed choice if they know the facts and the elderly can handle the facts better than any young person and doctors should realize this and be more frank. Some people on dialysis who are older than 80 say they would rather enjoy their last few years instead of having it on dialysis. They need an honest description of both sides of the coin: The best and worst of being on dialysis with their health and age, and the best and worst of letting their health take the natural progression of kidney failure.
However I can see where this could lead to corruption in the American medical system as doctors could write down in the chart that they decided to opt out of dialysis and just never offer it to the person or tell the family of the option (until a family member inquires about it). There would have to be investigations to make sure that the procedures are being followed properly but already existing procedures aren't being followed well enough as it is. It is no secret that they are looking for anywhere they can save money / cut costs, but it should never be Win for medical / loss for patient. Never. Doctors and any medical staff who sees a numerous amount of people pass away tend to be desensitized to death and feel that elderly patients should accept it as rationally as they and with grace. Too bad doctors have a hard time putting themselves in the shoes of someone just diagnosed and told they must start dialysis when they want to see their grandkids grow up and have so many hopes and dreams. There is more of a life than just the medical life. People naturally want to live. No matter how old someone is, they usually won't turn down dialysis unless they have already been through it before and had a very hard time and have second thoughts wondering if it is time to let things happen naturally, or have went through so many other things medically that they are more apt to accept what the doctor wants them to accept.
I can see doctors really want less elderly patients to be on dialysis but they should not persuade against dialysis but instead just lay the facts out evenly. All sides, without bias. Let people decide for themselves. However the nation is looking at how to cut costs and it is not necessarily at dialysis they should look at cutting but it is the easiest to blame nation wide. Not a lot is known about where the money goes and what actually costs what (at least most patients don't know exact figures) so it is easy to say it is a huge part of the nations debt.
What ever happens, the elderly should not be made into scape goats.
*Disclaimer: This is only my opinion by what I have heard over years from people and based on no facts but the article made me think.
