Giving up: discontinuation of dialysis
From the establishment of Scribner’s “Who Shall Live Committee,” to the present struggle to include all who might benefit from ESRD therapy, Carl Kjellstrand has served as a conscience for nephrologists. Illustrative of the breadth of Kjellstrand’s understanding of the socio-medico-psycho-economic interactions in renal failure therapy are his insights into the pathogenesis of withdrawal from dialytic therapy. Why, when there is competition to gain life-sustaining treatment will some who have been “fortunate” in gaining admission to a program opt to discontinue their treatment? While no single answer is self-evident, behavior of diabetic patients who so often are maimed and “beaten” by co-morbid diabetic complications offers important clues as to the rationale underlying the election of death.
KeywordsPeritoneal Dialysis Dialysis Patient Ethical Problem Lower Extremity Amputation Withdraw Life Support
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