[A difficult dilemma to resolve: aged patients refused for treatment by iterative hemodialysis. Ethical problem or medical choice? Reflections apropos of a questionnaire-inquiry].
An inquiry has been conducted amongst 185 french nephrologists so as to try to determine upon which criteria therapeutic choices for aged patients with chronic renal failure are made: conservative treatment or chronic dialysis? The fear of sharing the responsibility of an injustice towards some patients already handicapped by the disease or by their poor opportunity of social or family rehabilitation, the obsession of passive euthanasia and the refusal of taking into account the economic consequences of their choices, seem to conduct some nephrologists to accept anybody for a dialysis treatment. However, the quality of life enabled by the treatment, the possibility for the patient to enjoy a satisfactory social or family life, the environment of the patient, his degree of autonomy as well as, in some cases, the poor prognosis due to associated diseases, actually constitute the most determining factors of decision. The answer to this inquiry have moreover pointed out the necessity to provide right now for structures fitting the treatment by dialysis of an increasing number of elderly patients.
Pollini
J
J
Service de Médecine Interne-Néphrologie-Hémodialyse, Centre Hospitalier d'Avignon.
Teissier
M
M
D000368:Aged; D004989:Ethics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D011788:Quality of Life; D006435:Renal Dialysis / Q000191:economics / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
Un dilemme difficile à résoudre: les malades âgés récusés pour un traitement par hémodialyse itérative. Problèmes éthiques ou choix médical? Réflexions à propos d'un questionnaire-enquête.