Madam Chair, I must warn that the question asked by the hon member is extremely complex, very sensitive and highly emotional, because issues of renal dialysis are more often than not linked to transplant surgery. As hon members might know, the decision to do an organ transplant of any sort - whether it is renal or whether it relates to any other organ - is always a contentious issue. Fortunately, this question has been asked by a person who, I presume, in his career as a reverend has been faced with dilemmas of human compassion, ethics and matters of life and death.
The decision whether to dialyse or not is usually made by a group of physicians; it's never left to one doctor. The group of doctors make this decision taking cognisance of the resources that any particular country is able to accumulate, and that is where the complexities and emotions come in. I want to assure you, Reverend, that I personally would not like - at any stage of my life - to be in the boots of any group of doctors who must make a decision about whether to put a person on dialysis or not, or whether to do a transplant eventually.
It is quite often the devil's alternative, if you understand what I mean. Whichever decision one takes, the devil is always there to smile, because one is always going to be found wanting. I'm not talking about a problem that's confined to South Africa; it's a universal problem. Having said that, I want to acknowledge up front that there are not enough dialysis facilities anywhere on this continent. In fact, many of our neighbours might be depending on us.
However, when the physicians sit down to decide whether or not to put an individual in dialysis, the fact that a person comes from an impoverished background is not the primary reason why he or she is excluded from accessing dialysis treatment. This group of physicians usually makes this decision based on their experience. They have to assess whether there is going to be a reasonable chance of success or that the dialysis treatment will be of benefit to that particular individual. In this process physicians don't usually allow themselves to be persuaded by the social circumstances of the particular person.
However, because everything in life is interlinked, sometimes the medical decision the group of doctors makes may actually have been socially determined for the individual involved. For instance, they might decide that if a person has an intractable infection, they might not be able to do a dialysis on that particular person because, eventually, they can't do an organ transplant on that particular person.
Also, we do have people who can't undergo this type of procedure because they suffer from tuberculosis, TB, and have only one lung. Nevertheless, one knows very well that suffering from TB might be because of social circumstances. So, life is interlinked and the physicians make a decision based on that. At no stage will they ever be allowed to look at a person and say he or she is too poor for a transplant or dialysis. They won't do that.
However, after the decision is made, it is very easy to link these factors. For instance, if physicians decide that they are going to do a peritoneal dialysis, there needs to be clean running water at the patient's home for them to do so. If the individual does not have clean running water, science should not be blamed. It is a social problem that the country is faced with.
So, when we discuss this issue, I want us to be aware of the complexities that scientists are faced with when they have to make such a decision. It's never an easy decision but they are trying their best within the available resources. Therefore, I usually accept the decision the physicians make. I never go out and question them because I understand the background to their decisions. Thank you. [Applause.]