FORGOING RENAL DIALYSIS - A CASE-STUDY AND REVIEW OF ETHICAL ISSUES

End-stage renal disease is treated by long-term dialysis when renal tr ansplantation is not feasible, At a late stage in the disease, for a v ariety of reasons, dialysis is frequently stopped, This is one of the most common causes of death in dialysis patients, Ethical issues relat ed to withdrawal of dialysis are therefore commonly encountered in nep hrology practices, A case study involving discussions to forego dialys is in an incompetent patient is presented, and the ethical issues rais ed by this case, particularly related to the concepts of medical futil ity, informed choice, and justice are discussed, Finally, procedural a pproaches are suggested that will help to address the ethical problems raised and to assist in decision making at the time that the disconti nuation of dialysis is being considered. (C) 1996 by the National Kidn ey Foundation, Inc.