Is Quitting Dialysis Suicide

[idahospud]

I have a questen that was asks of me .So now i ask you all Dos the family still git to collect on you life insherens if you go off dialysis or not cues the insherens company calls it suicide? Yes we do need to redefine the worded so its exportable to all !           Carol

[BigSteve]

Good replies, Carol. I raised the question because I have spoken about my depression to both my
nephologist and my internist. Of course they both pill pushed, said they would give me anti-
depressive medication. I said no thanks because these meds just mask the reality of a dialysis
patient's life, dealing with a chronic illness that changes your life drastically.

[Zach]

I think it is suicide, but we need to be able to say that in some cases, suicide is a morally acceptable choice.  That's hard for some people, so we re-define suicide.

Excellent point.

[pelagia]

I think it is suicide, but we need to be able to say that in some cases, suicide is a morally acceptable choice.  That's hard for some people, so we re-define suicide.

Excellent point.

I can't agree that intentionally killing oneself, as most would define suicide, and allowing one's body to die of a disease or organ failure are the same thing.  I make the distinction based on the act itself - shooting oneself, jumping off a bridge, taking an overdose - those are acts I may decide to commit (or not).  Allowing my body to go its course would not be suicide in my book. I do not decide to have the disease, I decide how to treat it.

Now, then, is it suicide to smoke?  We could argue both ways I suppose, but most would not consider it an act of suicide even though it can mean death and people choose to smoke (or not). 

[Wallyz]

Again, that to me is analagous to saying that someone who refuses to eat is not committing suicide, they are just allowing nature to take its course.

[Kitsune]

But with that, you have chosen not to eat even though it is a small act that EVERYONE has to do to stay alive. It is not an unnatural means of life support, like dialysis, tube feeding or a ventilator. Eating does not reduce quality of life or leave the eater surviving but not truly living. Long-term eating does not have terrible side effects that may end up being worse than starving. So I stand by my statement. However, if people want to be or their caregivers want them to be on ventilators, dialysis, and feeding tubes, more power to them. But medical personnel, whatever their view on the matter do not have the right to intervene in the case of sane, competent people nor do they have the right to go against their Advance Directive if they do become unable to give consent, otherwise it would be considered medical battery, a very serious offense that can cause the loss of their medical license. That being, no the law does not view this as suicide, but merey "dying with dignity".

There was this one woman at my center (let's call her "Betty" for the sake of her family and also for the sake of respect and privacy to the deceased) who was in her 50's, in a nursing home, in a wheelchair, had heart failure, had a catheter, was in and out of the hospital frequently and had severe dementia from whatever. Betty did not know where she was half the time, screamed out in miserable pain, talked to herself and yanked out her cath repeatedly, spraying blood all over herself and her chair, and when she wasn't doing that, screamed to be taken off almost immediately after she got on the machine.

Yet Betty's sister, who was her guardian insisted that the treatments were beneficial to her even though Betty (whose treatments were suppsed to last 4 1/2 hours) maybe got in about 2-3 hours of her treatment on a good day, 10-30 minutes on a normal day and had an unacceptable Kt/v due to her drasticallly shortened treatments and the fact that she had a cath.

Now, Betty had no quality of life (she never left the nursing home she lived in, except to go to dialysis), she was mentally not there (when asked where she was at dialysis when she did speak, she would say that she was at the dermatologist or the beautician), her heart was failing, and she did not complete treatments. Betty ended up dying in the hospital 5 months after I started dialysis due to her heart failure anyway, but if her family had decided she had had enough and removed her from dialysis so she could die in peace like she said she wanted, would they have been killing her? No.

Just like if any one of us says "Enough is enough" and stops, we are not committing susicide, we are merely dying with dignity and I applaud anyone brave enough to end their suffering if that is what they feel is right.

But everyone has their own truth and as long as they don't push it on me, I respect it. But if they do, they WILL hear it from me at both ends.

[idahospud]

I'm going to try to do this one moor time my computer isaking up . So here i go Agni the the rd. I angry with both of you . We should have the right to chows to stop dialysis as long as a person is not psychotic and hearing voices telling you to stop dialysis . then medecol staff have to git an evaluation for you. Everybody at one time or a nuther has had some depression . its how you dell with it . The lady at your center Betty Yes it is sad to have to set and watch a family member not AWOL to let go . so the pt hasto suffer longer be-cos of it . That is why i have 2 Gordian's picktout my husband how will truly try to do as i wish and my sister how is stronger and he know this to . plus i have it in black and wight what i wont and don't wont . each state has a slightly different defunition of suicide. or end of life CARE I in my job have bin Abel to see both side of the fens with my job and some times i agree and some times  i feel like . wen that time comes for ency of us i hope its quick and panels for us all  which ever are chose ma be Carol

[Chris]

idahospud,
Looks like you need a new computer, computer maintenance, or a keyboard.

I got through most of what you wrote though.

[cedar]

What if someone with chronic kidney disease was told by thier doctor that they needed go on dialysis, and they decided to refuse this treatment?   What if the person told a family member or friend that, although the person was otherwise healthy, they were not going to go on dialysis?   Is it rational to refuse dialysis when a person is otherwise in good health?  The ethics of refusing treatment do not only affect the person with kidney failure, but those who are close to the person.   Whether or not family and friends admit it, the person may be not thinking clearly.  

If a person had been in an accident and refused help from paramedics, say for a broken leg that was bleeding, such an actions would be considered extreme.  As a society we would not condone a person who is injured refusing treatment.  We would try to find out why they do not want treatment, and if the condition is life threatening, give the treatment with or without consent.   It is a natural part of being human to want to help someone.   Kidney failure is a hidden disease, people cannot always tell how ill a person is from the outside.  This can lead to denial, even as refusing treatment will have a predictable outcome. 

In my case, I found there was no way to get help for my mother, even as I felt she was near death and that her decision did not seem to be rational.   Her doctor patient relationship was confidential and there is no law against a person refusing medical treatment as an adult.  I questioned myself if by not insisting she get counselling this amounted to assisted suicide, because in my conscience that is what I felt.   She perhaps needed some sort of intervention, but that would require the agreement of at least a majority of family members and some dared not go "against her".  Everyone thought that doctors were monitoring her, but she had basically told the doctors she was not going to listen to them, it was her choice. 

If a child is kept from dialysis by parents, for whatever reason, the child will be taken away from the parents for the safety of the child.  For a "rational adult" to refuse dialysis, there seems to be not much a person can do.   Unless they can be talked into counselling, and there are those who also will be able to seem rational to a counselor, but then not follow through.  

[willieandwinnie]

cedar, please go to the introduction section and tell us about yourself. 

[paul.karen]

It is a personal choice.

A GROWN person can decide not to do dialysis or Chemo or any other medical choice.
It can be hard on a family but think about the person who actually has the disease and then think about there wishes.

As for assisted suicide it should be legal and binding by law if the person is in full mental control and able to make such decisions.

It can be made so the patient feels no pain.
We just had a person mother here recently decide not to do dialysis.  There is a detailed thread of how it all went.  It was sad but in the end her family did what she wished for and made sure her last few weeks were comfortable for her.

Sometimes people know when it is there time. 
Other times maybe they just want to give up.

[Maxridex]

Firstly I've been disguested by this topic but let's face it NOT having Dialysis in my age = suicide without doubt. I'm the youngest on IHD aged 16. I will never thought of ending my dialysis and yes I admit that I had a thought about stop coming to hospital to dialysied beacuse it's annoying, boring, world torn us apart. Everyone here have felt that but it's their life their decision. I WILL never tell anyone on dialysis or other disease to give up on any treatment they are having. It's utter ridiculous, outrageous ! It's not like Sancitiy of life is it? It's you ! You make the decision to live or not. I'm agnostic but all I know is one truth everyone will die, so WHY ending it so early? I can't stand people giving up their lives.

OK on the other point of view. Pretending I'm 70- 90 I think well most people my age dies around this age anyway and I'm still suffering, shall I stop my treatment? So I will feel better... The FACT is no you won't feel better cause fluids adds up every day and the only way to get rid of it is dialysis. You won't feel any better anyway. IF you say you want to end dialysis ? Why don't you consider Voluntary-suicide ? I know everyone wants Euthanasia when their time is up.

Conclusion: NEVER GIVE UP, YOU WILL NEVER WALK ALONE ! Plus if you are bored invite friends, relative or anyone you know who's free and they can go and visit you. Do whatever possible but please,please and please don't end your life off-planned

-Maxridex

P.s I don't care or mind you hate me, everyone got their opinions. However I do care about the people who reads it all and get my message. Finally....
OH yeah I'm 16

[Stoday]

For me, the option of quitting dialysis is a better exit ticket.

Previously I felt happy that I'd sorted out an exit in the form of helium asphyxiation although that had the disadvantage that I had to be capable of ordering and receiviing balloons and a bottle of He. Now I don't have to cash in the new ticket until the last minute.

[cedar]

I understand that it is a "choice" to refuse dialysis, but sometimes it can be difficult to know if that choice is rational or if the person is "giving up".  If there are no other medical problems, it would seem like giving up.   Suppose person felt they should not get treatment, for the sake of others?

[Romona]

I will probably anger some people by saying this but here goes. Kidney disease is devastating. When given the options the person must make the decisions that are right for them. I was presented with three options. Preemptive transplant, dialysis when the time came or not be treated at all. I have children so I went for the transplant. But if I didn't have young children I may have made another choice. I wouldn't call not having dialysis or a transplant giving up. Is is selfish of the person that decides not to do treatment, to think of themselves and not their loved ones? Or is it selfish for the loved ones to disagree with that decision? Transplants and dialysis are not cures. There are risks and medical problems associated with both. The majority of people have a better quality of life with these treatments, some don't. If an informed person makes a decision it should be respected.

[Wallyz]

I tend to agree, Romona.  The OP's problem, (as I heard it) was thta she had no way of knowing whether the decision was informed or not, because her mother (his mother?  sorry gender wasn't clear to me) would not communicate about the decision.  This is the major problem.  People who under go trauma (like CKD-5 patients) can isolate and develop and exacerbate depression.  I think having a psych eval in this case would have been appropriate.

[cedar]

I wanted my mother to have an evaluation, but she "seemed rational" to others, and no one wanted to upset her by requesting clarification of her reasoning for refusing treatment.  I think people felt in general that the doctors had things under control and that she was listening to them, but she was not.  She also challenged anyone who tried to talk with her, as if they had the problem and she was fine.  This might be a natural reaction for some people, but in response to such a serious issue, it does not allow for solving anything.   Knowing my mother, I felt something was wrong, yet was told it was her own choice.   We were all to blame for not getting her help.   I feel that while choice is important, discussing a person's reasoning and plan for treatment is equally important.  It is not just about the person who has kidney failure, because people do want to help, and loved ones are affected as well.   

Thank you for your views on this subject, it really helps.  (And I am female, added that to my profile later). Thanks again.

[glitter]

But what if the person says, "I just dont want to do it- and thats my reason to choose no dialysis."

To whom does the reason have to be valid enough?

If thats the choice- there is nothing to solve, which is very painful for family. I sympathize with that 100%, when its your own ... you always want them to choose life no matter what.

Please understand I am not trying to be mean at all, and I mean no disrespect for your situation.

[Hanify]

Does anyone know what the insurance point of view is on this?  I.e if a patient chose to stop dialysis would they still pay out?  Or would they say it was suicide and refuse to pay?  I haven't entered the poll, cos I can't make up my mind.  Each time I read a post I think yeah, that's what I think, then I read another post with an opposing view and I think yeah, that's what I think.  This is possibly connected to the fact that I find it difficult to answer when someone asks me if I want tea or coffee.  Ha ha.

[cedar]

When someone you love is refusing dialysis, it can be important to know why, and saying "because that is my choice" may not be enough for others to have a reason to be able to come to terms with.   What if that choice were not based on rational ideas?  What if a person, having not ever had dialysis, had an impression that was not fully accurate?  What if the decision was based on fear?  This is the only life we have, and while of course it is the choice of the individual who has declining kidney function to received dialysis or not, at least in this country, sometimes a person may need feedback from others as well.   I am not saying that refusing dialsys may not be the right decision for a person, but the reasons behind the decision does matter to loved ones.  When anyone is facing such a situation, support seems absolutely necessary, and part of that would seem to involve understanding as much as possible what the person is going through. 

[Sluff]

I'm not going to pick a side because, I don't have to deal with dialysis as the rest of you do, but my question is if the doctor told you that you have cancer and there was no cure, but if you started a rigorous  treatment plan of chemo and radiation you could live longer, and you decided not to except that treatment. Would you consider that suicide?

[Tinah1968]

Does anyone know what the insurance point of view is on this?  I.e if a patient chose to stop dialysis would they still pay out?  Or would they say it was suicide and refuse to pay?  I haven't entered the poll, cos I can't make up my mind.  Each time I read a post I think yeah, that's what I think, then I read another post with an opposing view and I think yeah, that's what I think.  This is possibly connected to the fact that I find it difficult to answer when someone asks me if I want tea or coffee.  Ha ha.

My Uncle Died in March and his Insurance paid out. They said that he died of natural Causes. Which is true but it was his choice to stop Dialysis...      I have trouble with this subject becasue I am starting Dialysis and I do get depressed and just the thoughts that run thorough my head like .. Would it be better if I just didn't do Dialysis?, Would I not be a burden on my family...? But, then I see my Brothers and sisters and my nieces and nephews and I realize that the reason I want to live longer is Becasue of them and what they mean to me.. I choose to Fight and be a VICTOR not a VICTIM.... I have to for myself. But, that is my choice. Each of us have things in our lives that we wish we could change I am sure that all of us wish that Kidney Disease did not exisist.
But, it does and someone once told me it is not the trials and turbulations in life that define us it is how we handle it and get through it that makes us stronger.

[cedar]

I can only imagine what it must be like to make the decisions someone who needs dialysis must make.   Sometimes though if no real decision is made, that in and of itself can become the decision because time eventually will take care of things.  Even if someone does not want to be forced into something, the disease itself will not repsect that wish.  

I do not believe that the "burden theory" holds true for close family members themselves.  At the same time, it is not their choice.   If someone's quality of life becomes "not worth it" that may change things, but it would seem to make that decision before trying is speculation.  

The life of a person with kidney failure matters a great deal to loved ones, even as the decision is not theirs.

[willowtreewren]

My SIL said for years that she would not go on dialysis - that she would just go out in the field and die first. Her husband was pretty upset with this decision, but never pressured her.

Part of her reason for not wanting dialysis was having seen the difficulties her father had many years ago.

In the end, she choose to do NxStage. It isn't easy, but it keeps her alive and doesn't have all the negatives she envisioned.

I think being well-informed is important. Once a person knows as much as possible, the final decision should be theirs. No one can really fully understand what others are living through. We shouldn't judge others for their choices. Those choices may not be the ones we would make, but we don't live in their skin.

Matthew, I think you are very wise for someone who has only lived for 16 years. Please continue to share that wisdom.

Aleta

[glitter]

 
To the insurance question- my husband was told before he started, by a doctor, if he didn't want to do dialysis, it was not considered suicide and the insurance would pay out. It would be considered natural causes.