Practical considerations in dialysis withdrawal: "to have that option is a blessing".
Cessation of life-support treatment is an appropriate option for situations in which the burdens of therapy substantially outweigh the benefits. Decisions to withdraw dialysis now precede 1 in 4 deaths of patients who have end-stage renal disease. Guidelines have been recently published to assist clinicians in making these complex and emotionally charged determinations, and they include: relying on shared decision making by all participants, obtaining informed consent, estimating the prognosis on dialysis, adopting a systematic approach for conflict resolution of disagreements, honoring advance directives, and ensuring the provision of palliative care. These principles are discussed in relation to an elderly man with dementia whose family decided to terminate maintenance hemodialysis.
Cohen
Lewis M
LM
Department of Psychiatry, Baystate Medical Center, Springfield, Mass 01199, USA. lewis.cohen@bhs.org
Germain
Michael J
MJ
Poppel
David M
DM
D016223:Advance Directives; D000368:Aged; D001293:Attitude to Death; D001294:Attitude to Health; D026688:Bioethical Issues; D015897:Comorbidity; D003657:Decision Making; D006801:Humans; D007258:Informed Consent; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D010166:Palliative Care; D010347:Patient Care Planning; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D028761:Withholding Treatment / Q000941:ethics / Q000331:legislation & jurisprudence / Q000592:standards