STOPPING DIALYSIS OF AN INCOMPETENT PATIENT OVER THE FAMILYS OBJECTION - IS IT EVER ETHICAL AND LEGAL

Decisions to stop dialysis or other life-sustaining treatments for inc ompetent patients are among the most difficult ethical problems faced by physicians and families. This observation is verified by the large number of court cases and the increasing frequency of ethics consultat ions on these issues. In such instances, in the absence of an advance directive, the usual practice for physicians is to turn to the patient 's family for direction on whether to start, continue, or withdraw the treatment. They do so on the presumption that the family best represe nts the patient's interests. This presumption may not always be correc t. A case is presented in which the family's insistence on continued d ialysis was contrary to the patient's previously expressed wishes and the treating physician's assessment of the patient's best interests. I t is asserted that, in such situations, after thorough conversation wi th the family, consultation, documentation, and an unsuccessful attemp t to transfer the patient's care to another physician, nephrologists h ave an ethical obligation and legal right to override the family's dec ision and to stop dialysis. The ethical obligation is supported by the principles of respect for persons, beneficence, and nonmaleficence. T he legal right is grounded in common law and state statutes.