title: Discontinuing dialysis in persistent vegetative state: the roles of autonomy, community, and professional moral agency.
abstract: This report proposes a policy for discontinuing dialysis in persistent vegetative state (PVS) patients and attempts to address autonomy and community-based values while maintaining professional moral agency. It is recommended that the policy be adopted at a regional level (eg, the ESRD Network). The involved physicians and ethicists would communicate with the next-of-kin and surrogate decision-makers, and the local ethics committee would perform a double review of the case to assure the appropriateness of the policy to the case. Given the unique nature of PVS with its permanent loss of consciousness and autonomy, we hold that a community-based consensus can form a guideline that limits futile dialysis while respecting patient and professional moral agency. Prior consent of dialysis patients to the regional policy at a time shortly after initiating dialysis will add to its ethical impetus.
authors.affiliation: Department of Ambulatory and Primary Care, Elmhurst Hospital Center, and the Mt Sinai School of Medicine, New York, NY, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Eiser
authors.forename: D J
authors.initials: DJ
authors.lastname: Seiden
mesh_terms: D016223:Advance Directives; D026686:Beneficence; D032921:Consensus; D003657:Decision Making; D034462:Dissent and Disputes; D026822:Ethicists; D028741:Ethics Committees, Clinical; D004992:Ethics, Medical; D005066:Euthanasia, Passive; D005610:Freedom; D006126:Group Processes; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D018447:Medical Futility; D010344:Patient Advocacy; D010530:Peritoneal Dialysis; D018458:Persistent Vegetative State / Q000150:complications / Q000628:therapy*; D026684:Personal Autonomy; D006435:Renal Dialysis; D040841:Resource Allocation; D028761:Withholding Treatment