[Should dialysis be for all? Comment].
Legal and ethical aspects of withholding or withdrawing dialysis are still matter or debate and it is impossible to present a course of action that would always be correct. Dialysis is an extraordinary, high cost and invasive treatment. Therefore the possibility to withhold or withdraw this treatment should be discussed in each single case, after evaluating comorbidities, expected survival, rehabilitation, quality of life, psychosocial cost and clinical complications. On these basis competent patients have the possibility to give or deny their consent to the treatment and to change this decision at any time. In incompetent patients doctor should try to understand what the patient would choose if he were competent or help family to decide what action would achieve the best interest of the patient. The Catholic Church considers it acceptable to withdraw or withhold extraordinary therapies whose final effect is a mere prolongation of survival with an unacceptably poor quality of life (no apparent therapeutic benefit). It is often inhumane to ask the family to decide to let a patient die. This should be a medical proposal to be accepted by the family after an appropriate information on possible alternatives. Finally palliative care and medical and social assistance should be provided to help the patient and his family.
De Vecchi
A F
AF
U.O. Nefrologia e Dialisi, Ospedale Policlinico Mangiagalli, Regina Elena, Fondazione IRCCS, Via Commenda 15, Milan, Italy. deveccpd@policlinico.mi.it
D005066:Euthanasia, Passive; D006801:Humans; D007258:Informed Consent; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010166:Palliative Care; D010358:Patient Participation; D006435:Renal Dialysis / Q000941:ethics*; D028761:Withholding Treatment