Dignity or denial? Decisions regarding initiation of dialysis and medical therapy in the institutionalized severely mentally retarded

Decisions regarding health care of the severely mentally retarded can be di fficult. We present 2 cases of patients with severe mental retardation who lived in long-term care facilities. Both patients had progressive loss of r enal function and eventually reached end-stage renal disease. In each case, the decision was made not to initiate dialysis. We discuss issues of dialy sis and medical care of the severely mentally retarded and advocate using t he principles of "best respect" and "best interest" in making medical decis ions in this population.