WITHDRAWAL FROM DIALYSIS - ETHICAL ISSUES

Since 1991, death following withdrawal from dialysis has increased gre atly in our dialysis unit. This report is based on our observations of those patients who followed that course. Four types of patients who w ithdrew from dialysis were identified: Those with a terminal illness, demented patients, those with a progressive disability, and those who had no serious medical problem other than end-stage renal failure. We analyzed the risk factors for withdrawal and attempted to define th et hical principles involved in each patient category. The authors conclu de that although the decision of a competent patient to stop dialysis must be honored, some of those deaths might be preventable if patients on chronic dialysis are prospectively followed and treated by those w ho are expert in the behavior of patients with chronic illness.