Committee members listened for the factors they’re supposed to consider when deciding whether to accept someone for the dialysis program.
Phillips “never smoked, never used any drugs,” Swart continued. “He only drank over weekends with his wife, but they would only buy about four bottles, 750 ml., between the two of them.” Phillips was, Swart said, “not a party animal.”
That was a point in his favor. Under the guidelines, active substance abuse automatically excludes a patient from receiving dialysis.
Swart also discussed Phillips’s living conditions. “It’s a one bedroom house, with a lounge, kitchen, and a bathroom,” she said. The bathroom had a tub, sink, and a toilet.
The guidelines call these “good home circumstances,” and they, too, improved Phillips’s chances of being chosen for dialysis. Doctors say having running water, sanitation and electricity is helpful for a certain type of dialysis performed at home. However, these criteria disadvantage the poorest South Africans, who often lack utilities at home.
Swart offered more personal details. “He is employed on a farm,” she said. “His income is more or less 1,200-1,500 rand a month.” He had “no criminal record” and was married to a 33-year-old woman. “They’ve got three children of 13, 9, and 4 years old, all three living with them.”
These factors—criminal and employment history, whether the patient is a parent—have little to do with the chances of benefiting medically from dialysis. They are, instead, a measure of social worth.
Dr. Moosa says the committee used to weigh these factors heavily when considering patients for dialysis. “I suppose we used a utilitarian approach,” he said. “The question that we used to ask ourselves—you know, if we put this patient onto our program, of what benefit can he be to the society?”
: and moan on an internet forum. The only thing that creates change in America is political action. So go out there and support your candidates and organizations. Raise your voices and make yourselves heard. I know that's what I'm doing. Together, we'll all come up with compromises that work for America. 
