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"To Have That Option Is a Blessing"

Amy J. Markowitz, JD; Michael W. Rabow, MD

JAMA. 2003;290:815.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In April 2003, Cohen et al¹ introduced Mr D, an elderly man with dementia whose family struggled to make the decision to terminate maintenance hemodialysis after 10 years. The authors suggest that cessation of life-support treatment for patients with end-stage renal disease should generally be considered when the burdens of therapy substantially outweigh its benefits. Decisions to withdraw dialysis now precede 1 in 4 deaths of patients who have end-stage renal disease. The authors recommend use of guidelines that have been recently published to assist clinicians in making these complex and emotionally charged determinations. The guideline principles 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. Cohen et al discuss the stages and methods for . . . [Full Text of this Article]

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