Ethical conflicts for physicians treating ESRD patients.

Managing an end-stage renal disease (ESRD) patient is complex and presents many ethical challenges for the physician. Ownership of dialysis facilities has shifted over the past decade from largely nonprofit organizations to large companies whose shareholders are primarily interested in the profitability of their investments rather than the well-being of the patients being treated. Furthermore, market forces rather than scientific questions that need to be answered now drive much of the research regarding patients with ESRD. These developments have created ethical dilemmas for treating physicians. This editorial describes some of these ethical challenges and expresses the point of view that the doctor-patient relationship and its ethical imperatives are more important than company profit and loss statements.