Foregoing renal dialysis: a case study and review of ethical issues. The End-Stage Renal Disease Group.
End-stage renal disease is treated by long-term dialysis when renal transplantation is not feasible. At a late stage in the disease, for a variety of reasons, dialysis is frequently stopped. This is one of the most common causes of death in dialysis patients. Ethical issues related to withdrawal of dialysis are therefore commonly encountered in nephrology practices. A case study involving discussions to forego dialysis in an incompetent patient is presented, and the ethical issues raised by this case, particularly related to the concepts of medical futility, informed choice, and justice are discussed. Finally, procedural approaches are suggested that will help to address the ethical problems raised and to assist in decision making at the time that the discontinuation of dialysis is being considered.
Tobe
S W
SW
Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
Senn
J S
JS
D000368:Aged; D004992:Ethics, Medical; D005066:Euthanasia, Passive; D005260:Female; D006801:Humans; D007258:Informed Consent; D007676:Kidney Failure, Chronic / Q000628:therapy*; D018447:Medical Futility; D016743:Mental Competency; D010530:Peritoneal Dialysis; D016414:Resuscitation Orders