Sw. Tobe et Js. Senn, FORGOING RENAL DIALYSIS - A CASE-STUDY AND REVIEW OF ETHICAL ISSUES, American journal of kidney diseases, 28(1), 1996, pp. 147-153
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.