Life and death in a welfare state: end-stage renal disease in the United Kingdom.

The uniquely parsimonious approach to treatment of end-stage renal disease patients in the U.K. was initially developed under the imprimatur of the nation's medical elite and sanctioned by the central government. Public value for public money and an equitable balance of scarce resources among many social and medical claims still guide the National Health Service. But these clinically dominated allocative decisions are imperfect, often counter-productive, and, ultimately, political. There is a marked dissonance between compassionate and bureaucratic themes.