Advance directives and withdrawal of dialysis in the United States, Germany, and Japan
A. R. Sehgal, C. Weisheit, Y. Miura, M. Butzlaff, R. Kielstein and Y. Taguchi
Division of Nephrology, MetroHealth Medical Center, Cleveland, Ohio 44109-1998, USA.
OBJECTIVE: To determine the role of advance directives in decisions to
withdraw chronic dialysis in the United States, Germany, and Japan. DESIGN:
Survey by questionnaire. PARTICIPANTS: Seventy-two American, 87 German, and
73 Japanese nephrologists. MAIN OUTCOME MEASURES: 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.
Withholding or withdrawing dialysis in the elderly: the perspective of a western region of France
Clement et al.
Nephrol Dial Transplant 2005;20:2446-2452.
ABSTRACT
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Case study: dementia, quality of life, and appropriate treatment.
Baumrucker
AM J HOSP PALLIAT CARE 2005;22:385-391.
Death after withdrawal from dialysis: the most common cause of death in a French dialysis population
Birmele et al.
Nephrol Dial Transplant 2004;19:686-691.
ABSTRACT
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Palliative care for patients with end-stage renal failure: reflections from Central Australia
Fried
Palliat Med 2003;17:514-519.
ABSTRACT
Living With Death: The Meaning Of Acceptance
Connelly
Journal of Humanistic Psychology 2003;43:45-63.
ABSTRACT
A messy necessary end: Health care proxies need our support
Goldblatt
Neurology 2001;56:148-152.
ABSTRACT
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Ethical Decision Making and Patient Autonomy : A Comparison of Physicians and Patients in Japan and the United States
Ruhnke et al.
Chest 2000;118:1172-1182.
ABSTRACT
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Dying Well After Discontinuing the Life-Support Treatment of Dialysis
Cohen et al.
Arch Intern Med 2000;160:2513-2518.
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Cross-Cultural Primary Care
Perkins and Hazuda
ANN INTERN MED 2000;132:164-164.
FULL TEXT
Dialysis Patients' Preferences for Family-Based Advance Care Planning
Hines et al.
ANN INTERN MED 1999;130:825-828.
ABSTRACT
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