Dialysis TransplantationEthical Issues in Dialysis Issues surrounding the withdrawal of dialysis treatment

members of the team that dialysis gives them noIntroduction worthwhile life), say that they wish to withdraw from treatment and die. There are, however, a few who,Withdrawal of and withdrawal from dialysis treatment when faced with end-stage renal failure, genuinely dohas become a significant cause of death in renal patients not wish to prolong their life by undertaking dialysis.particularly in the United States and Canada, where Others may have already received treatment for sometreatment withdrawal is the second commonest single years and feel that the time has come to stop.cause of death in patients aged>65 years (17%) These two groups are very diVerent from each other.following cardiovascular disease [1]. The increase in In the first case, the patient has no real idea what lifedialysis withdrawal coincides with far more liberal on dialysis is like. If such a patient agrees to a trial ofcriteria for acceptance of patients for renal replacement treatment, it may, in fact, be better than expected ortherapy. Advanced age and co-morbidity per se are no it may be as bad, or worse. The long-standing dialysislonger considered contraindications for treatment. patient however, knows what we have to oVer and isBefore considering the dilemmas of withdrawal of in a better position to decide. The mentally competenttreatment, or of the patient who decides not to accept patient on dialysis has, in fact, control over thethe option of dialysis, it is useful to restate the aim o