At the University of Washington in the early 1960’s, Dr. Beldning Scribner devised a way to provide a permanent hemodialysis access to renal failure patients. The invention of the Scribner shunt turned a procedure that could only be used for a few weeks into a chronic therapy and thus paved the way to the saving of countless lives. Prior to the introduction of the shunt, a vascular cut down procedure had to be done each time a patient underwent treatment and the supply of usable sites for the cut down was soon exhausted.
Nephrology Center of the World
Scribner’s discovery made Seattle the nephrology center of the World. At that time, 10,000 people were estimated to die of renal failure each year. When the doors of Seattle Artificial Kidney Center at Swedish Hospital opened in January 1962, it was the only outpatient dialysis unit in the country. There were 3 treatment slots and 60 persons in the surrounding community who needed them.
To treat eleven patients required two full time physicians and one part time physician, five nurses and five technicians. At that time, funding for the dialysis clinic was extremely limited and resources had to be used as effectively as possible. Patients were initially screened for medical suitability to receive the new chronic outpatient dialysis treatments. But, even after the medical screening process more patients remained than their were machines and personnel to treat them.
The ‘God’ Committee
The hospital established the Admissions and Policy Committee later to be called the ‘God Committee’, to determine who should morally and ethically be chosen to receive these coveted, life saving treatment slots. The committee was composed of a minister, a lawyer, a homemaker, a state government official, a banker, a labor leader, and a surgeon who served as a doctor-citizen. The committee positions were all unpaid and operated on anonymity. They reviewed things like the patient’s criminal background, net worth, number of dependents, education, and marital status.
As other dialysis units were formed, so were other committees. Each one defined their own set of eligibility criteria. When Time magazine ran an article detailing the functions of the Admissions and Policy Committee, public furor ran high. Public pressure led Congress to subsidize ESRD therapy for all Americans.
By 1967, the group was disbanded as dialysis services no longer needed to be rationed. These committees live on as a historic milestone of human medicine. They were the first bioethics committees, and the choices and issues that they struggled with then are as gripping as the ones that face medicine today.