DISCONTINUING DIALYSIS IN PERSISTENT VEGETATIVE STATE - THE ROLES OF AUTONOMY, COMMUNITY, AND PROFESSIONAL MORAL AGENCY

This report proposes a policy for discontinuing dialysis in persistent vegetative state (PVS) patients and attempts to address autonomy and community-based values while maintaining professional moral agency, It is recommended that the policy be adopted at a regional level (eg, th e ESRD Network), The involved physicians and ethicists would communica te with the next-of-kin and surrogate decision-makers, and the local e thics committee would perform a double review of the case to assure th e appropriateness of the policy to the case, Given the unique nature o f PVS with its permanent loss of consciousness and autonomy, we hold t hat a community-based consensus can form a guideline that limits futil e dialysis while respecting patient and professional moral agency, Pri or consent of dialysis patients to the regional policy at a time short ly after initiating dialysis will add to its ethical impetus. (C) 1997 by the National Kidney Foundation, Inc.