Is Quitting Dialysis Suicide

[stauffenberg]

Obviously, the whole question of whether quitting dialysis is suicide or not is a matter of semantics.  To say it is not suicide because the patient is simply withdrawing life-support treatment is silly, since a person who ceases to eat or drink, or puts a bag over his head so he can't breathe, is also withdrawing life-support treatment from himself, and everyone would characterize this as suicide!  Just because eating is normal life-support while dialysis is an unusual  form of life-support does nothing to change the matter.  That said, the Roman Catholic Church has held in the famous case of Mr. Cinque, who wanted to terminate his dialysis in a Catholic hospital in New York in 1985, that ceasing dialysis is not suicide, since it is merely the withdrawal of 'extraordiinary means' used to sustain life.  But the significance of this distinction is too Jesuitical to make sense to me.

Also, it is perfectly legal to commit suicide, in contrast to what some posters maintain.  Laws against suicidie existed in most Western countries until the 19th century, when the suicide of a British Prime Minister, Lord Castlereigh, made suicide seem respectable enough to be de-criminialized.  Some insurance companies do in fact pay out on life insurance policies even if the person insured has killed himself, as long as that event occurs more than 2, or with some companies, 3 years after the policy was taken out.  The fact that most companies will not pay has nothing to do with suicide being illegal, just with company policies.

Personally, I applaud those on dialysis who have the courage to commit suicide, since I find these courageous people in some ways more life-affirming than those who continue with dialysis.  To kill oneself on dialysis says that the patient values the dignity of true human life so highly he is so profoundly offended by the living death that one is forced to endure on dialysis that he prefers to die rather than disgrace his humanness with the inadequate existence provided by a machine that can only replace 10% of normal renal function.  I say this as someone who, during the eight years I was on dialysis, frequently considered suicide but simply lacked the courage to do it, however right the decision seemed.  The irrational, instinctive will to live at all costs, even if life has become a disgrace to human dignity, is very difficult to overcome.

[angieskidney]

the Roman Catholic Church has held in the famous case of Mr. Cinque, who wanted to terminate his dialysis in a Catholic hospital in New York in 1985, that ceasing dialysis is not suicide, since it is merely the withdrawal of 'extraordiinary means' used to sustain life.  But the significance of this distinction is too Jesuitical to make sense to me.

I am curious. What did the Catholic church say? The reason I am curious in what they said is because I am Roman Catholic.

[goofynina]

Hi Stauffenberg,  I dont think we've had the pleasure of meeting you.  Can you please go to the introduce yourself section and tell us more about you?  You seem very informative and i am sure you have lots to share with our little community here.   Hope to hear from you again soon...

[imacrash]

I would have to say it's a form of suicide.  Last year when I became very depressed, I told the social worker that I wanted to quit and she called 911 and I ended up in the hospital for a few days.  There are many forms of suicide, such as, not complying with your med schedule or being a drug or alcoholic addict, missing dialysis treatments for no reason.  Nearly anything to extreme came be labeled "suicide or suicidal".

[kitkatz]

Personally, I applaud those on dialysis who have the courage to commit suicide, since I find these courageous people in some ways more life-affirming than those who continue with dialysis.  To kill oneself on dialysis says that the patient values the dignity of true human life so highly he is so profoundly offended by the living death that one is forced to endure on dialysis that he prefers to die rather than disgrace his humanness with the inadequate existence provided by a machine that can only replace 10% of normal renal function.

Are you nuts??? I for one value my life as I am still contributing to society in many ways.  I value the dignity of life and would definitely go off dialysis when I am no longer able to function.  Dialysis does not have die in it you know!

[angieskidney]

Dialysis does not have die in it you know!

It does here

[kitkatz]

But you have to spell it dielysis

[MelissaJean]

Personally, I applaud those on dialysis who have the courage to commit suicide, since I find these courageous people in some ways more life-affirming than those who continue with dialysis.  To kill oneself on dialysis says that the patient values the dignity of true human life so highly he is so profoundly offended by the living death that one is forced to endure on dialysis that he prefers to die rather than disgrace his humanness with the inadequate existence provided by a machine that can only replace 10% of normal renal function.

Are you nuts??? I for one value my life as I am still contributing to society in many ways.  I value the dignity of life and would definitely go off dialysis when I am no longer able to function.  Dialysis does not have die in it you know!

I definitely agree Kitkatz!  Even though sometimes it sucks, what in life doesn't?  However, I can see where stauffenberg is coming from.  If you absolutely abhor doing dialysis and you are so miserable, yet you continue on because you are scared to die, you might see a person who quits dialysis as courageous.

[kevno]

Tell you the truth I am so appalled with what you wrote Stauffenberg. You applaud those on dialysis who have the courage to commit suicide So in your view, what you wrote, NO one should be alive on dialysis We should all have knocked ourselves off years ago. I have been back on dialysis for over 18 years now. Had my ups and downs. But until I can not bounce back to reasonable health. Would never consider suicide. I know we all hate to have to rely on a machine to live. But in my view the courage is in the fight to survive, not the cowards way out with suicide.

The cowards way out. I do know three personally who have stopped dialysis. But they had no hope even to survive on dialysis. No Way do I think they were Cowards. I am talking about patients who are reasonable well (what ever that is ) and stop dialysis.

[Sara]

Personally, I applaud those on dialysis who have the courage to commit suicide, since I find these courageous people in some ways more life-affirming than those who continue with dialysis.  To kill oneself on dialysis says that the patient values the dignity of true human life so highly he is so profoundly offended by the living death that one is forced to endure on dialysis that he prefers to die rather than disgrace his humanness with the inadequate existence provided by a machine that can only replace 10% of normal renal function.  I say this as someone who, during the eight years I was on dialysis, frequently considered suicide but simply lacked the courage to do it, however right the decision seemed.  The irrational, instinctive will to live at all costs, even if life has become a disgrace to human dignity, is very difficult to overcome.

Are you insane?   

[BigSky]

Obviously, the whole question of whether quitting dialysis is suicide or not is a matter of semantics.  To say it is not suicide because the patient is simply withdrawing life-support treatment is silly, since a person who ceases to eat or drink, or puts a bag over his head so he can't breathe, is also withdrawing life-support treatment from himself, and everyone would characterize this as suicide!  Just because eating is normal life-support while dialysis is an unusual  form of life-support does nothing to change the matter. 

The problem in that theory is in that eating and drinking are not considered extra ordinary measures to stay alive.

In order to commit suicide one needs to take some out of the ordinary measure.  Declining medical intervention in a terminal disease has never been viewed as out of the ordinary.

[sandman]

Also, it is perfectly legal to commit suicide, in contrast to what some posters maintain.  Laws against suicide existed in most Western countries until the 19th century, when the suicide of a British Prime Minister, Lord Castlereigh, made suicide seem respectable enough to be de-criminalized.  Some insurance companies do in fact pay out on life insurance policies even if the person insured has killed himself, as long as that event occurs more than 2, or with some companies, 3 years after the policy was taken out.  The fact that most companies will not pay has nothing to do with suicide being illegal, just with company policies.

In what country is this?  In the US, if someone else saves you from yourself, you are force to seek psychiatric help or for repeat offenders, typically submitted to a psychiatric hospital.  And life insurance companies will NOT pay out if it was proven that the person in question had committed suicide.

Personally, I applaud those on dialysis who have the courage to commit suicide, since I find these courageous people in some ways more life-affirming than those who continue with dialysis.  To kill oneself on dialysis says that the patient values the dignity of true human life so highly he is so profoundly offended by the living death that one is forced to endure on dialysis that he prefers to die rather than disgrace his humanness with the inadequate existence provided by a machine that can only replace 10% of normal renal function.  I say this as someone who, during the eight years I was on dialysis, frequently considered suicide but simply lacked the courage to do it, however right the decision seemed.  The irrational, instinctive will to live at all costs, even if life has become a disgrace to human dignity, is very difficult to overcome.

  Are you insane?  I would applaud those on dialysis who have the courage to NOT commit suicide.  I can only imagine the severity of the emotional factor here considering that I personally, have not gone through that ordeal of dialysis but WOW!  How did you come to this conclusion?

Obviously, the whole question of whether quitting dialysis is suicide or not is a matter of semantics.  To say it is not suicide because the patient is simply withdrawing life-support treatment is silly, since a person who ceases to eat or drink, or puts a bag over his head so he can't breathe, is also withdrawing life-support treatment from himself, and everyone would characterize this as suicide!  Just because eating is normal life-support while dialysis is an unusual  form of life-support does nothing to change the matter. 

The problem in that theory is in that eating and drinking are not considered extra ordinary measures to stay alive.

But they can be in the right scenario.

[Rerun]

Personally, I applaud those on dialysis who have the courage to commit suicide, since I find these courageous people in some ways more life-affirming than those who continue with dialysis.  To kill oneself on dialysis says that the patient values the dignity of true human life so highly he is so profoundly offended by the living death that one is forced to endure on dialysis that he prefers to die rather than disgrace his humanness with the inadequate existence provided by a machine that can only replace 10% of normal renal function.  I say this as someone who, during the eight years I was on dialysis, frequently considered suicide but simply lacked the courage to do it, however right the decision seemed.  The irrational, instinctive will to live at all costs, even if life has become a disgrace to human dignity, is very difficult to overcome.

This is excellently said, and I agree wholeheartedly.  (Wish I would have said it)

I'd been on dialysis before and then got a transplant that lasted for 17 years (I know you have heard that a million times now) BUT, I never intended to go back on dialysis once my transplant gave out.  I didn't have the courage to do it.  I would have saved myself 10 surgeries so far......

[BigSky]

But they can be in the right scenario.

Not for able people.

[sandman]

But they can be in the right scenario.

Not for able people.

Well what about those TV commercials we see where people in poor, 3rd world counties who can't find enough food and water.  You would not consider that, extra ordinary measures to stay alive?

[BigSky]

Well what about those TV commercials we see where people in poor, 3rd world counties who can't find enough food and water.  You would not consider that, extra ordinary measures to stay alive?

Nope, not even close. 

To eat food and drink is an normal ordinary measure of everyday life.  Just because there may be a lack of it doesn't make it an extra ordinary measure.

To be extra ordinary it has to be something that is not of the norm.  Last I knew the world around, eating was a normal thing to do.

[kitkatz]

I voted no it is not suicide to stop dialysis.  I already told you all that if the circumstances were right I would end it and quickly. I would hope my partner and family would be respectful and not leave me as a muttering nonsense vegetable on dialysis.  At least make sure I have a quality of life.  I cannot understand why in our unit a lady who has Alzheimer's in on dialysis. She had no idea what is happening to her and can be belligerent and fight the staff. She also yells crazy things all night.  She has to be sedated before they bring her into the unit.  Is this the way to treat our elders? Are we showing her respect? Are we prolonging her life for the right reasons?  When the time comes for me, let me go!

[stauffenberg]

Although people might try to impose various psychotherapeutic interventions even on those who rationally try to commit suicide, suicide is still not illegal anywhere in the Western world today.  The illegality of suicide used to mean that the body could not be buried in a public cemetery, and that the will was invalid, with the entire estate being confiscated by the state rather than going to the appointed heirs.

Food and water are the things people ordinarily need to stay alive, and if they stop taking these and die, society would not hesitate to call that action suicide.  Dialysis is what endstage renal patients ordinarily need to stay alive, so when dialysis patients cease to dialyze, this is suicide in exactly the same way as an ordinary person refusing to eat and to drink is.  To say that one person is committing suicide because his action represents the withdrawal of an 'ordinary' support of life while another person is not committing suicide because he is withdrawing a support for life which is statistically unusual in the population, and thus 'extraordinary,' seems to me to be an utterly arbitrary distinction.  If my house is on the edge of a cliff so I have to take extraordinary precautions when leaving my house in the dark so as not to die by falling off the edge, if I deliberately decide not to be careful then that is suicide, however 'extraordinary' it may be to have to take such measures to survive!

[angieskidney]

Tell you the truth I am so appalled with what you wrote Stauffenberg. You applaud those on dialysis who have the courage to commit suicide So in your view, what you wrote, NO one should be alive on dialysis We should all have knocked ourselves off years ago. I have been back on dialysis for over 18 years now. Had my ups and downs. But until I can not bounce back to reasonable health. Would never consider suicide. I know we all hate to have to rely on a machine to live. But in my view the courage is in the fight to survive, not the cowards way out with suicide.

The cowards way out. I do know three personally who have stopped dialysis. But they had no hope even to survive on dialysis. No Way do I think they were Cowards. I am talking about patients who are reasonable well (what ever that is ) and stop dialysis.

That is how I feel! And that is who I meant! I don't expect any young people to want to end their life because dialysis seems too hard! Life is hard! But I still say to not do dialysis is not suicide. Just how I feel. I feel suicide is to deliberately end your life .. a healthy life .. because you are depressed or grieving .. those people need help. But a dialysis patient .. one who is old and dialysis is just prolonging their life when it is at a stage where they have already lived their life .. then if they decided to put their lives into God's hands and live their last days eating what ever they like and drinking what ever they like and just enjoying life, then let them. It could be said that they are not doing suicide but finally living out the last days of their lives.

Well what about those TV commercials we see where people in poor, 3rd world counties who can't find enough food and water. You would not consider that, extra ordinary measures to stay alive?

Nope, not even close.

To eat food and drink is an normal ordinary measure of everyday life. Just because there may be a lack of it doesn't make it an extra ordinary measure.

To be extra ordinary it has to be something that is not of the norm. Last I knew the world around, eating was a normal thing to do.

I agree! Dialysis is an extra ordinary measure and eating and drinking are NOT.

[BigSky]

Except that dialysis is not ordinary as you try to suggest.  Anytime a person is in END STAGE such actions taken to prolong life against natural process are considered extra ordinary. 

Hmm if house was  on a cliff huh.

Then maybe you can explain the difference between ordinary precautions while living on a cliff and extra ordinary precautions living on a cliff.

[Sluff]

This is just too complicated for me.  It's a persons right to seek medical attention or not. My parents both decided chemo wasn't doing it 4 them and they died with dignity by there own choices. Do I think they committed suicide? Absolutely not.

[hemohortensia]

The Merriam-Webster definition of "suicide" is:

1 a : the act or an instance of taking one's own life voluntarily and intentionally especially by a person of years of discretion and of sound mind

Apparently M-W has trouble with the word since the definition is convoluted. According to this definition, somebody who "voluntarily and intentionally" takes their life because they don't like the colour of the sky is of "sound mind". They probably mean as opposed to insane but in the US, the legal definition iof sane is knowing the difference between right and wrong. And "years of discretion" has me stumped.

Let's assume that"extra ordinary" is an action taken to prolong life against natural process.
Taking insulin is an action taken to prolong life against natural process.
If a diabetic refuses to take insulin is that suicide or not?
If suicidal patients refuse to take anti-depressants which suppress the suicidal ideation refuse to take the anti-depressants because they prolong life against the natural process which is to commit suicide, then what? (Wrap your mind around THAT!)

 

I  believe in the right of dialysis patients to terminate. It was one of the first things I asked. I was told that yes, I could quit if I wished but that the staff hoped that I would talk to them before taking such a step. Knowing that I can stop has ironically kept me going.

[stauffenberg]

The way statistics are collected in the United States, voluntarily withdrawing from dialysis is not counted as suicide, though this is a bureaucratic, not a philosophical determination.  Statistics show that per 100 patient-years, 3.5 patients will die from voluntarily withdrawal from dialysis.  One way to see this is to say that if a patient were to stay on dialysis for a century, he would have decided to let himself die rather than continue 3.5 times.  Or, more plausibly, if a patient stays on dialysis for 10 years, his chances of deciding to give up on the treatment are 35%.

The actual suicide rate among American dialysis patients, in addition to those who voluntarily withdraw from dialysis therapy, is almost twice as high as in the general population, or 1.84 times higher than the average rate.

[Zach]

The way statistics are collected in the United States, voluntarily withdrawing from dialysis is not counted as suicide, though this is a bureaucratic, not a philosophical determination.  Statistics show that per 100 patient-years, 3.5 patients will die from voluntarily withdrawal from dialysis.  One way to see this is to say that if a patient were to stay on dialysis for a century, he would have decided to let himself die rather than continue 3.5 times.  Or, more plausibly, if a patient stays on dialysis for 10 years, his chances of deciding to give up on the treatment are 35%.

The actual suicide rate among American dialysis patients, in addition to those who voluntarily withdraw from dialysis therapy, is almost twice as high as in the general population, or 1.84 times higher than the average rate.

You always have the most fascinating statistics.  How many are transplant patients whose grafts failed and went back on dialysis?  That could be the tipping point.

How about some annotation?

 

[stauffenberg]

I got my information from M. Kurella, et al, "Suicide in the United States End-Stage Renal Disease Program," Journal of the American Society of Nephrology, 16 (3) (March, 2005) 774-781 and R. B. Fissell, et al, "Factors Associated with 'Do Not Resuscitate' Orders and Rates of Withdrawal from Hemodialysis in the International D.O.P.P.S.," Kidney International, 68 (3) (September, 2005) 1282-1288.

Every renal patient should get involved in reading medical journals and monographs, since that is where you can find the truth that the nephrologists and dialysis nurses don't want you to hear.  Typing in "Entrez Pubmed" on the internet is a good first step, since that gives you ready access to abstracts of millions of medical journal articles published over the last 30 years.