When Enough Is Enough: The Nephrologist's Responsibility in Ordering Dialysis Tr

[okarol]

When Enough Is Enough: The Nephrologist's Responsibility in Ordering Dialysis Treatments
Michael J. Germain, MD, Sara N. Davison, MD, Alvin H. Moss, MD
Received 20 January 2011; accepted 18 March 2011. published online 23 May 2011.
Corrected Proof

Abstract
For more than 20 years, nephrologists have been reporting that they are increasingly being expected to dialyze patients whom they believe may receive little benefit from dialysis therapy. During this time, there has been substantial research about the outcomes of patients of differing ages and comorbid conditions requiring dialysis and the development of clinical practice guidelines for dialysis decision making based on research evidence, ethics, and the law. The importance of palliative medicine to the care of the patient throughout the continuum of kidney disease also has been recognized, and its application has been described. This article summarizes these advances and provides an approach for decision making and treatment for patients who are not likely to benefit from dialysis therapy.

http://www.ajkd.org/article/S0272-6386(11)00738-4/abstract#article-footnote-1

[Dannyboy]

I have only the "free" membership to that website....is the article worth joining the pay side?
---Dan

[natnnnat]

I will have access to the article when it is published (it is still in preview mode prior to coming out in the next issue (vol 57 issue 6 I guess it will be in).
If you want I can email the full article to you then.  Send me your email via PM.
The article outline (of headers) is as follows:
Article Outline
Case presentation
Introduction
Ethical Principles Underlying Decisions to Forgo Dialysis
    Patient Preferences
    Physician Responsibilities
    Legal Aspects
Symptom Burden and Psychocognitive Considerations
Cultural and Ethnic Concerns
Withholding Dialysis Therapy
Withdrawing Dialysis Therapy
Time-limited Trial
Discussions With Patient and Family
Palliative/Supportive Care
Conclusions and Recommendations
Acknowledgements
References