Experts recommend patients talk with their physicians and a social worker or therapist to understand their choices and know what to expect. There are many reasons why someone with ESRD may not want to continue or start dialysis. Studies have shown that people most likely to withdraw from dialysis are older and living in nursing homes. They often have health problems in addition to kidney disease, and suffer more severe pain.
They usually have physical limitations that restrict normal daily activities. Planning for care and respecting the wishes of the patient makes end-of-life decisions easier. All adults should have an advanced directive. Having an advance directive lets everyone know what to do if you become unable to communicate those wishes. If you have questions about an advance directive, please talk with your physician or an attorney. When someone has made the decision to stop dialysis, hospice can be referred by their physician.
For more information on hospice, talk to your physician. Without dialysis, toxins build up in the blood, causing a condition called uremia. The patient will receive whatever medicines are necessary to manage symptoms of uremia and other medical conditions. Depending on how quickly the toxins build up, death usually follows anywhere from a few days to several weeks.
As the toxins build up, a person may experience certain physical and emotional changes. If you have missed several treatments, you may have some discomfort when you first start dialysis again.
You should discuss the possibility of returning to dialysis with your doctor. You can name someone such as a spouse, adult child or close friend to make medical decisions for you, such as stopping dialysis, in case you are no longer able to make these decisions for yourself. This is done by filling out a form called a health care proxy or a durable health care power of attorney. The person you name to make medical decisions for you is called a surrogate.
It is important to make sure the person is willing to act on your behalf and that he or she knows your short- and long-term goals, values and what treatments you would or would not want to have if you were not able to speak for yourself. The role and responsibilities of the surrogate, as well as the types of decisions the surrogate may make, may vary from state to state, depending on the law of that state.
Generally, the surrogate must follow your wishes. For more information about naming a surrogate and about the laws in your state, you may speak with an attorney or the social worker at your unit. If you decide to stop dialysis treatment, you or your surrogate may want to make sure the following items are in order:.
Click here to access a PDF of this information. If you would like more information, please contact us. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations. Skip to main content. Dialysis: Deciding to Stop.
Can I really stop dialysis treatment if I want to? If I ask to stop dialysis, how will the health care team at my unit respond? How do I discuss my decision with my family and friends? Can any changes be made in my treatment that might improve my quality of life?
Will I be asked to speak to a mental health professional? Is stopping dialysis considered suicide? How long will I live if I choose to stop dialysis?
What should I expect after stopping dialysis? What type of food and drink could I have? Will my renal health care team continue to help me? Can I get hospice care?
Do I have a choice of where I die? Many, she says, are concerned that even broaching such subjects as death, dying, and withholding treatment will lead to despair and loss of hope. Addressing these issues, however, tends to have the opposite effect. When patients are allowed to talk openly about their fears, Dr. In addition to their fear of upsetting patients, doctors feel awkward because they lack training in how to deal with end-of-life issues.
Despite the increasing influence of the hospice and palliative care movements, medical schools and residency programs are only now starting to incorporate instruction in this subject. But that comfort level is often hard-won. Holley, for example, says that going through the deaths of both her parents taught her important lessons. Among other things, the document discusses shared decision-making, how to estimate prognosis, conflict resolution, and when it is ethically appropriate to withhold or withdraw dialysis.
Some cases are easier Whether physicians are aware of the guideline or not, experts say that when it comes to withdrawing or withholding care, some cases are easier to call than others. For example, when a patient with profound, irreversible neurologic damage has left written advance directives, and his family members agree that he would not want to continue living, the decision to end care is fairly simple.
Moss recalls a patient who, despite relative good health, wanted to stop treatment at age Ultimately, Dr. Moss had the patient evaluated and treated for depression, and the patient changed his mind. Moss says. More often, however, Dr. We want you to keep going.
0コメント