title: Withdrawal from long-term hemodialysis in patients with end-stage renal disease in Taiwan.
abstract: Withdrawal from dialysis is ethically appropriate for some patients with multiple comorbidities and a shortened life expectancy. Taiwan has the highest prevalence of dialysis patients in the world, and the National Health Insurance (NHI) program offers renal replacement therapy free of charge. In this review, we discuss its current status and many background issues related to withdrawing dialysis from patients with advanced renal failure in Taiwan. Compared with dialysis therapy, the medical resources for hospice care are relatively sparse. Since the announcement of the Statute for Palliative Care in 2000, there has been a gradual improvement in the laws and health polices supporting dialysis withdrawal. Culture and social customs also have a significant impact on the practice of hospice care. Based on current evidence and in accordance with the local environment, we propose recommendations for the clinical practice of dialysis withdrawal and hospice care. There remains a need to expand upon the community-based hospice care and home care systems to better serve patients. In conclusion, there are cross-cultural differences relating to dialysis withdrawal between Taiwan and Western countries. Our experience and clinical recommendations may be helpful for the countries with NHI systems or for the Eastern countries.
authors.affiliation: Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Chun-Fu
authors.initials: CF
authors.lastname: Lai
authors.forename: Hung-Bin
authors.initials: HB
authors.lastname: Tsai
authors.forename: Su-Hsuan
authors.initials: SH
authors.lastname: Hsu
authors.forename: Chih-Kang
authors.initials: CK
authors.lastname: Chiang
authors.forename: Jenq-Wen
authors.initials: JW
authors.lastname: Huang
authors.forename: Sheng-Jean
authors.initials: SJ
authors.lastname: Huang
mesh_terms: D003469:Culture; D006291:Health Policy; D006301:Health Services Needs and Demand; D017051:Hospice Care; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013624:Taiwan; D028761:Withholding Treatment / Q000941:ethics / Q000331:legislation & jurisprudence
keywords: advance care planning; medical ethics; palliative care; personal autonomy; withholding treatment