“I Expect Attendees to Emerge From This Session With New Perspectives on Ethical Decision-Making” – Dominique Martin on Ethical Practice in Kidney Care at WCN’23 and Current Research on Ethical IssuesReema Parmar
Professor Dominique Martin (Australia) will co-chair the “Ethical Practice in Kidney Care – Managing Unexpected Challenges” session on Saturday, April 1, from 11:45 – 12:45.
Professor Martin is a member of the ISN-ASN-ERA joint ethics task force and a professor of health and professionalism at the School of Medicine at Deakin University in Victoria, Australia.
We asked her about the ethics session at WCN’23, its importance to nephrologists, what she’s looking forward to in the future of kidney care, and her current research projects on ethical issues in organ and tissue donation and transplantation.
What can we expect from the session on ethical practice in Kidney Care at WCN’23?
This will be a fantastic, thought-provoking session featuring talks on three very different but current and complex ethical challenges in kidney care. I expect attendees to emerge from this session with new perspectives on ethical decision-making in clinical practice and research.
Dr. Priya Pais (India) will explore the issue of parental refusal of pediatric dialysis in resource-limited settings. Many clinicians grapple with this ethical challenge daily, but it may be a largely unfamiliar issue to those working in higher-income countries.
Dr. Andrej Skoberne (Slovenia) will discuss ethical considerations relating to kidney care in humanitarian crises. Many countries continue to be impacted by war or natural disasters, which in turn can adversely affect neighboring countries or regions tasked with providing care to refugees and other migrants.
Finally, Professor Jayme Locke (US) will explore the ethical challenge of selecting candidates for kidney xenotransplant trials. With several new interventions and technologies emerging as potential solutions to kidney failure, the issue of selecting trial candidates is one that I think will resonate with many clinician-researchers.
Which ethical considerations in kidney care are most important for nephrology clinicians practicing worldwide to be aware of?
That’s a tricky question – it’s the equivalent of asking about the most important clinical considerations! If I must choose, I’d say firstly, justice or fairness in access to and outcomes of care, without which clinical and scientific progress is meaningless.
Secondly is relational autonomy. By empowering patients to have control over their health and healthcare and to be actively engaged in decision-making – in collaboration with clinicians, family, carers and others – we support better decision-making all round in clinical practice and policymaking, leading to better outcomes for all.
Even where patients may have few, if any, choices about their treatment, ensuring they have an informed understanding of their kidney health is essential to support the broader autonomy of individuals and communities.
What excites you about the future of kidney care?
Three key things: Firstly, the increased space given to research, policymaking, and people with kidney disease in decision-making about their care. This helps drive innovation and change in ways that more effectively meet the needs of people receiving kidney care.
Secondly, emerging treatments and interventions that give hope to so many people with kidney failure, such as xenotransplantation, organ regeneration and repair technologies, and more affordable home dialysis systems.
Thirdly, growing attention to diversity and inclusion across the field of kidney care, which means not only greater efforts to address inequities in access to care, but also more opportunities for everyone to benefit from and build on the knowledge, expertise, skills and ideas of people and populations who have previously been excluded from leadership roles, research, and policymaking.
What is the core focus of your current work?
I’m working on several projects at the moment! I’m involved in a multi-stage project to collect data on international travel for organ transplantation alongside colleagues from the Declaration of Istanbul Custodian Group and supported by the ISN and The Transplantation Society.
In collaboration with colleagues at the Philippine Society of Nephrology, I’m working on a pilot project to develop a curriculum framework for ethics in kidney care.
Another key current project involves exploring ethical considerations in research involving potential deceased donors during the end-of-life period.
What do you want to achieve with your research?
In most of my research, I aim to shed light on and provide guidance for addressing ethical concerns in clinical practice, research or health policy.
Ethics is such a fundamental part of kidney care, but not every clinician or researcher has the time or expertise to engage in depth with all the ethical aspects of their work. Sometimes the ethical dimensions of a problem might be missed, and by helping to tease these out, I hope to facilitate ethical practice and policy.
Doing so benefits patients by helping to improve ethical decision-making, enhance fairness in resource allocation, and avoid disproportionately burdensome care. It can also help reduce ethical anxiety or moral distress on the part of health professionals.