Advance directives and withdrawal of dialysis in the United States, Germany, and Japan.
OBJECTIVE
To determine the role of advance directives in decisions to withdraw chronic dialysis in the United States, Germany, and Japan.


METHODS
Survey by questionnaire.


METHODS
Seventy-two American, 87 German, and 73 Japanese nephrologists.


METHODS
Each nephrologist's total number of (1) dialysis patients, (2) cases of withdrawal of dialysis, (3) patients with advance directives, and (4) uses of such directives. Nephrologists also stated whether they would continue or stop dialysis in 8 hypothetical cases.


RESULTS
American, German, and Japanese nephrologists reported withdrawing dialysis for 5.1%, 1.6%, and 0.7% of their patients in the last year, respectively. Thirty percent of American patients had advance directives, and such directives were used in decision making for 3.2% of all patients. Only 0.3% of German and Japanese patients had advance directives, and such directives were used in decision making for 0.09% of patients. When asked about a hypothetical mentally incompetent patient whose family requests withdrawal of dialysis, American nephrologists were much more likely to stop dialysis in the absence of an advance directive than German or Japanese nephrologists. However, almost all nephrologists from the 3 countries would stop dialysis when a family request to withdraw was supported by a patient advance directive.


CONCLUSIONS
There is a high prevalence of advance directives among American dialysis patients, and such directives frequently play a role in decision making. German and Japanese nephrologists appear willing to follow advance directives, but the low prevalence of such directives limits the frequency of their use.
Sehgal
A R
AR
Division of Nephrology, MetroHealth Medical Center, Cleveland, Ohio 44109-1998, USA.
Weisheit
C
C
Miura
Y
Y
Butzlaff
M
M
Kielstein
R
R
Taguchi
Y
Y
D024362:Advance Directive Adherence; D016223:Advance Directives; D003657:Decision Making; D005858:Germany; D006801:Humans; D007258:Informed Consent; D038622:Internationality; D007564:Japan; D016015:Logistic Models; D016743:Mental Competency; D009398:Nephrology; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D006435:Renal Dialysis; D011795:Surveys and Questionnaires; D014481:United States; D028761:Withholding Treatment