By examining the ethical features of dialysis withdrawal as well as transcultural differences in attitudes toward withdrawal, one can have a better understanding of the role of autonomy and community-based values on medical decision-making.
Three distinctive patterns of withdrawal are described herein.
The first concerns patients suffering from an advanced state of physical or mental decline.
When a patient or health care surrogate decision maker requests cessation of therapy because it fails to be beneficent for the patient in his or her totality, the physician should be prepared to cooperate, in accord with beneficence and nonmalfeasance as well as autonomy.
The second pattern occurs when the patient loses decisional capacity, and the surrogate decision maker makes unreasonable requests for nonbeneficial care.
At issue is what constitutes nonmaleficence and beneficence in this setting, the provider and surrogate differing on whether continuing dialysis constitutes beneficence.
Such a dilemma can alleviated by community-based consensus guidelines with consent of the patient before losing capacity.
The dialysis network is potentially a unit of patient and professional community.
In third pattern, the patient's decision to withdraw appears to be inappropriate to their potential for benefit from continued therapy.
The nephrologist and patient are conflicted on what constitutes beneficence, with the former holding that continuation is morally superior.
Mots-clés Pascal : Dialyse péritonéale, Arrêt traitement, Indication, Critère décision, Autonomie, Demande déterministe, Résultat, Homme, Epuration extrarénale, Rein pathologie, Appareil urinaire pathologie
Mots-clés Pascal anglais : Peritoneal dialysis, Withdrawal, Indication, Decision criterion, Autonomy, Deterministic demand, Result, Human, Extrarenal dialysis, Renal disease, Urinary system disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0195962
Code Inist : 002B27B03. Création : 199608.