Ending dialysis raises some tough questionsBy BILL KETTLER
Mail Tribune, South Oregon
When a cancer patient stops chemotherapy or radiation, most people can accept that decision, but opinion is more divided on stopping treatments such as dialysis that are perceived as less painful, says medical ethicist Dr. Susan Tolle.
People are generally sympathetic when someone stops treatments that are in themselves "a profound burden" and offer little hope of extending life, said Tolle, director of the Center for Ethics in Health Care at Oregon Health & Science University.
Many people are much more uncomfortable when someone ends a treatment such as dialysis, which is perceived as life-extending with relatively few painful side effects.
"The question is whether (stopping dialysis) is letting nature take its course, or somehow not working to sustain life as you're obligated to do," she said.
Tolle said for people who have serious multiple medical problems, "dialysis is more painful than most people realize."
"The sicker you are the worse you feel with dialysis," she said.
Tolle said research indicates 15 percent of all people on dialysis at any given moment will discontinue it voluntarily. She said that decision to stop dialysis is not all that different from a cancer patient's decision to reject a fourth round of painful chemotherapy to spend one's final days at home in peace.
Oregon leads the nation in the percentage of people who die at home, rather than in a nursing home or hospital. Tolle said the majority of nursing home residents say "no" to some kind of treatment at the end of life.
Many leave written instructions not to be revived if they suffer a stroke or heart attack. Others might even refuse oral antibiotics or just stop eating and drinking.
"Most people with advanced chronic diseases make a plan to limit (treatment) at the end," she said.
"It's common. It's not shameful," she said. "It's what Oregonians do, quietly and privately."
Reach reporter Bill Kettler at 776-4492 or e-mail bkettler@mailtribune.com.
http://www.mailtribune.com/archive/2007/0406/local/stories/decision-side.htm
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