Practical Considerations in Dialysis Withdrawal
"To Have That Option Is a Blessing"
- Amy J. Markowitz, JD;
- Michael W. Rabow, MD
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- caregivers
- dialysis, renal
- family caregivers
- guidelines
- kidney failure
- patient-physician relationship
- renal dialysis
- terminal care
- withholding treatment
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 implementing these guidelines to help physicians facilitate …
