Ethical Issues in Dialysis
Aaron Spital, Series Editor: Quality End‐of‐Life Care in Dialysis Units

Abstract

Quality end-of-life care has not been a priority in dialysis units and patients often experience prolonged dying while suffering needlessly. Advance directives (ADs) and decisions to stop dialysis have been highlighted by the medical profession as priorities in improving the quality of care, yet these are only two aspects of end-of-life care. They may not reflect patients' priorities and may not have the expected impact in improving the quality of end-of-life care. This review argues that quality end-of-life care should be a clinical priority in the care of dialysis patients; end-of-life care needs to be developed primarily from the patients' perspective; a clinical framework is required that integrates many aspects of end-of-life care; and end-of-life care should be initiated much earlier in the course of patients' illnesses than traditionally is done. By communicating more effectively and sooner with patients, their values and needs can be identified so we will be better able to plan and facilitate their end-of-life care and improve their experience of dying.

Unravelling complex choices: multi-stakeholder perceptions on dialysis withdrawal and end-of-life care in kidney disease

“…Instead of viewing it as a means to relieve suffering, dialysis withdrawal was often dismissed as “giving up” or even akin to a form of suicide. While some studies showed that patients may express interest in dialysis withdrawal due to declining quality of life [ 12 , 18 , 41 ], most patients in our study had become accustomed to their dialysis routines even though some expressed treatment fatigue and suicidal thoughts. Consequently, the idea of contemplating end-of-life care remained a distant consideration, denying the necessity to discuss it until continuing dialysis would become medically untenable.…”

Improving Advance Care Planning in Chronic Kidney Disease

“…Goals-of-care discussions, palliative care, and symptom management are clinical priorities for CKD patients (Davison, 2001). The decision to start dialysis or have medical management without dialysis is a difficult choice, made even more difficult if the patient and family do not understand the implications of beginning dialysis with multiple comorbidities and advanced age.…”

Expectations of patients for the support and the support for hemodialysis patients given by nurses

“…Tylko niewielki odsetek zareagował obojętnie (10,0%). Taka reakcja jest oczywista, bowiem dla wielu pacjentów, jak wskazują inni autorzy, dializoterapia wydaje się nawet rozłożonym w czasie procesem umierania [11].…”