Dialysis at the end of life: when is withdrawing ethically justified?

Abstract

Introduction: Chronic kidney disease is a significant cause of death. Those who progress to end-stage renal disease often start dialysis as a life-saving treatment. There are several ethical issues related to decision-making on withholding / withdrawing dialysis, particularly for patients with cognitive impairment and comorbidities, where the decision becomes more complex. Objective: The case of a 56-year-old patient, suffering from laryngeal cancer and end-stage chronic renal failure in three times a week hemodialysis treatment, as well as other comorbidities is analyzed. So, we want to deal with ethical aspects regarding the assessment of proportionality and ethical-clinical appropriateness of dialysis treatment in patients with a short-term prognosis and cognitive impairment. Discussion: Although in principle dialysis treatment, as a replacement treatment of renal function, has always a palliative purpose and is technically feasible, in some circumstances it could occur as an overtreatment and painful prolongation of the dying process. Conclusions: An interdisciplinary assessment and the patient’s family involvement was important for assessing the clinical appropriateness and ethical proportionality of dialysis treatment. This assessment led to the development of a “Shared Document for Healthcare Ethics Planning”. The objectives of care and the patient’s good were identified within this document.