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

  • Barbara Corsano Servizio di consulenza di etica clinica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italia; Centro di ricerca per la Bioetica clinica e le Medical Humanities (CRiBCeMH), Università Cattolica del Sacro Cuore, Roma, Italy.
  • Dario Sacchini | dario.sacchini@unicatt.it Servizio di consulenza di etica clinica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italia; Centro di ricerca per la Bioetica clinica e le Medical Humanities (CRiBCeMH), Università Cattolica del Sacro Cuore, Roma, Italy.
  • Nicola Panocchia U.O.C. di Nefrologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma; Università Cattolica del Sacro Cuore, Roma, Italy.
  • Antonio G. Spagnolo Servizio di consulenza di etica clinica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italia; Centro di ricerca per la Bioetica clinica e le Medical Humanities (CRiBCeMH), Università Cattolica del Sacro Cuore, Roma, Italy.

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.

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Published
2022-11-03
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Original Articles
Keywords:
chronic kidney disease, clinical ethics, consultation, overtreatment, proportionality
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How to Cite
Corsano, B., Sacchini, D., Panocchia, N., & Spagnolo, A. G. (2022). Dialysis at the end of life: when is withdrawing ethically justified?. Medicina E Morale, 71(3), 333-343. https://doi.org/10.4081/mem.2022.1215