Nephrol Dial Transplant (2004) 19: 536-540
Nephrol Dial Transplant Vol. 19 No. 3 (c) ERA-EDTA 2004; all rights reserved
Editorial Comment
From curing to caring: one character change makes a world of difference. Issues related to withholding/withdrawing renal replacement therapy (RRT) from patients with important co-morbidities
1Renal Division and 2Hospital Ethical Committee, University Hospital Ghent, Ghent, Belgium
Correspondence and offprint requests to: Wim Van Biesen, Department of Nephrology, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium. Email: wim.vanbiesen@ugent.be
Keywords: co-morbidity; ethics; renal replacement therapy; withdrawal
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Introduction |
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The widespread availability of renal replacement therapy (RRT), the technical improvements in RRT techniques and the improved survival of patients with associated important co-morbidities, such as diabetes and cardiovascular disease, have led to a situation where, technically speaking, virtually every patient can be accepted for RRT. It appears that widespread access to RRT has shifted the initial dilemma of which patients should be selected for RRT (positive selection) to the question of which patients should not be initiated on RRT (negative selection). This ethical problem is not only limited to the single patient level (will this particular patient benefit from RRT), but also relates to the community level, as RRT places an important burden on the health care budget, and choices have to be made in selecting health care priorities in some countries (the problem of sustainable development). In addition, survival on RRT has improved. The majority of end-stage renal
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Decision analysis: to treat or not to treat |
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About curing and caring |
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A caring approach with a trial of RRT |
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A caring approach to withdrawing RRT in chronic RRT patients |
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Conclusion |
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