Is Quitting Dialysis Suicide

[Rerun]

Everyone is going green and natural and organic.... so I think to forgo dialysis would be the thing to do.  Only if you want to put needles in your arms and have your blood cleaned and put back in you so you can live 3 more days.

[noahvale]

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[jeannea]

Rerun, you're right. We are not being green. All that trash and water and electricity used on us.

[amanda100wilson]

I hope you really don't view it like that, ReRun.  must be hard if you do.

[jbeany]

Hmmm - gotta say I had the same thought when I started NxStage and saw how much trash I was producing!  Not that I planned to stop because of it, but geez, it was tough to realize how much plastic I was using weekly that couldn't be recycled because of the biohazard.

[amanda100wilson]

I know, it does play on my mind too, but I was always a worrier, and at the sge of eight in the seventies, way before they used to worry about trash and recycling etc., I used to worry about  it.  Was always a strange kid.  was told to draw a giant when .i was about six years old.  most people drew a picture of a man with nothing to show how big he was.  I just drew a pair of legs, gecausemy giant was so bigbthat he wouldn't fit on the page.  Used to look at a map of the World, and think about how the continents looked like they fitted together, not many years after the theory of plate tectonics wasfirst suggested.  Anyway, I am wittering here, but I just wonder what happened to my brain along the way?  All that creative thinking soon disappeared!

[Hemodoc]

Thanks Noahvale. I will probably update my blog quite soon. My nephrologist in Spokane WA is retiring, so I sought a new unit. They are VERY unsupportive so far and Group Health likewise. Will see how things go, but there is a possibility they won't approve my home dialysis. I have other options that can kick in on August 1st, but I will let them play it out. Sadly, the state of dialysis in America is still abysmal.

Back to the topic of this thread, withdrawal of medical care is actually a fairly common occurrence that I dealt with quite frequently in my practice. As a matter of fact, the very last patient I took care of in the hospital the night I was on call for the last time, Labor Day weekend 2005. I had actually seen him 3 days earlier and he wished to continue all therapies despite very advanced metastatic cancer. Three nights later, he showed up in the ER comatose and septic. I discussed the options with his family and they agreed that any further treatment was futile. I placed him on comfort measures only which in his case was a morphine drip and IV fluids to prevent the discomfort of severe dehydration. He died a few hours later.

There are very well thought out protocols and ethical paradigms to deal with these situations. Once again, withdrawal of care is a very common occurrence in daily medical practice.

[amanda100wilson]

Hemodoc, I welcomed your input on this.

[Rerun]

Peter, did I see you in the Ironman competition??  Ha Ha...   The weather today was so strange.  Thunder all day!!  Never seen that before. 

I would hope when it was time to quit there would be help doing so.  Comfort measures?  I like that.

[amanda100wilson]

Gosh, Rerun, you certainly don't live in Georgia.  A few weeks ago we had a thunderstorm that lasted from 5.30 in the evening to 5.30 the next morning.  The lightning and thunder were constant throughout!

[Hemodoc]

Peter, did I see you in the Ironman competition??  Ha Ha...   The weather today was so strange.  Thunder all day!!  Never seen that before. 

I would hope when it was time to quit there would be help doing so.  Comfort measures?  I like that.

Ironman in Coeur D Alene? Sorry, must have been my twin brother. I would like to see Shad come through here but he told me the water in CDA is too cold and that is probably quite true.

 Dying from uremia is not a pleasant affair from all that I have read. Folks do go on hospice but it isn't the sort of thing I would want to contemplate. I think I would rather jump in Lake Coeur D Alene before going through that type of experience. Sadly, many on dialysis never see the true benefits of an extended protocol. I readily understand why folks would not want to continue with conventional in-center dialysis. Doing daily dialysis at home, the "usual" side effects of dialysis are essentially absent. In reality, the "usual" side effects of dialysis are in many ways iatrogenic and quite specific to the American experience in many ways.

[noahvale]

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[Hemodoc]

Wow, 23 years of in-center dialysis. That is quite a testament. 

Group Health has never supported daily dialysis. I was told on Friday by the financial supervisors of FMC in their Arizona center that everything is approved. I will have to see how everything sits tomorrow. I will play it by ear. But to date, not very supportive at all.

Deciding when to withdraw therapy can at times be an easy decision giving the circumstances of continuing but in other cases, it is a quite difficult choice. Thankfully, the guidelines today are well defined, or at least they were while I was practicing.  Withdrawing care in the face of uremia is one of the difficult situations for certain.

[charmed]

Just wanted to add, im 23 year on dialysis and have just now had enough. Not sure what happened or when or what triggered it. But I know I have now had enough and want a change. I am in the UK and under a great Unit.  I told my nurses and they have send me to a counsellor who is talking about family and childhood and stuff. I will keep going but have for the first time in 23 years started missing days. One thing that doesn't help is the wiped out feeling after dialysis, even into the next day I recover around 3pm the next day but that doesn't help a person who is intelligent and cannot work. Home to dialysis  recover and go back. No life. Might try home dialysis. just wanted to add. fight on friends.

[AnnieB]

Charmer, if you haven't tried home dialysis yet maybe that might be a better way to go. From what I've read on this site, many people have seemed pretty happy with PD and they don't have to deal with the wiped-out feelings that are so common with in-center. Whatever you decide, I wish you the best. 

Anne

[Hemodoc]

Just wanted to add, im 23 year on dialysis and have just now had enough. Not sure what happened or when or what triggered it. But I know I have now had enough and want a change. I am in the UK and under a great Unit.  I told my nurses and they have send me to a counsellor who is talking about family and childhood and stuff. I will keep going but have for the first time in 23 years started missing days. One thing that doesn't help is the wiped out feeling after dialysis, even into the next day I recover around 3pm the next day but that doesn't help a person who is intelligent and cannot work. Home to dialysis  recover and go back. No life. Might try home dialysis. just wanted to add. fight on friends.

The wiped out feeling is from dialysis that is too fast, too infrequent and takes off too much fluids in too short a time. Home hemo allows a more physiologic approach to this. I hardly ever feel "wiped out" after dialysis. In fact, I get off and I am off and running so to speak. I wish you well my friend but the solution is MORE dialysis not less and the only place to get more dialysis is at home. PD is an option for many folks but it does NOT improve overall survival. At your young age, home hemo and transplant give the greatest longevity in general.  Best wishes and hope you feel better soon.

God bless,

Peter

[hillary]

I feel very strongly about this topic.  I waited 2 years to deal with dialysis (my neph told me long ago that I really needed it) before I was forced to get a chest perma cath last week when I basically ran out of time.  The whole time I was avoiding it, my family was accusing me of killing myelf.  I did not see it that way all.  I saw it as dying with dignity and on my own terms.  I had vey skewed images of what it would be like to have a chest cath and I pictured myself lying in bed 24/7 with no quality of life at alll.   I have since learned that is not the case, it doesn't have to be.  But I will defend ALWAYS a person's right to decide what to do with their own life and their own death.  I think it's horrible that you are allowed to put an animal out of its misery, but you are not allowed to assist in the humane and dignified death of a loved one. Really messed up world we live in.

[PatDowns]

" I believe the debate whether or not withdrawal from dialysis is suicide is a rhetorical fiction. I think the real question is whether or not you feel it is morally wrong to willfully take your own life. If you do think it is morally wrong, then I don't think it matters whether you put a bullet in your head while you are healthy, or whether you pull the plug on dialysis treatments which are maintaining your life. The point is you are willfully killing yourself. Arguments that taking oneself off dialysis is not suicide because you are only allowing nature to take its course are not impressive. That's like arguing that if a parachutist removes his parachute on the descent, it is not suicide because he is only allowing nature to take its course after removing the artificial support system.

I believe we all have that choice, and as a 17 year home hemodialysis patient I can see how patients like myself might get into a medical situation that is intolerable.

I have noticed that there are a lot of articles in the nephrology literature lately which discuss withdrawal from dialysis. It seems that many nephrology professionals are beginning to view withdrawal as a viable option for some patients. The thing that bothers me is that they all put the burden on the patient. Many of them describe death by uremia as a "good death." I think this is a bunch of bull. I've always read that death by uremic poisoning is one of the worst deaths that one could have, and the times I've stretched the interval a little I felt horrible. I don't think I would ever allow myself to die of uremia. I would take action while I was still in good shape.

An ESRD patient who has made an informed decision to end life should not be expected to check into a hospital and slowly die of uremia even though the process may be ameliorated by narcotics. Nephrology professionals should face up to their obligation to their patients who need physician assisted suicide. Dr. Kevorkian has certainly advanced the debate, and I imagine it won't be long until physician assisted suicide will be an accepted practice in the U.S. "

George Harper, MEd, EdS
14 Oct 1997

Home Hemodialysis - 1980-2002
Transplant - 2002-present

http://www.rsnhope.org/programs/kidneytimes-library/article-index/living-long-and-well-on-dialysis/

[amanda100wilson]

I am not sure that I understand the parallel with a parachutist.  Parachuting out of a plane, is in itself, an un-natural act.  A normally-healthy body with working kidneys, performing a normal physiological function, is not.  Dialysis replaces this normal physiological function.  Not doing dialysis is also a passive action.  Removing a parachute is not.  I understand that the outcomes may be the same, but that is where the parallel begins and ends.

[ianch]

I'm firmly on the Pro choice side here, but I do live in a different country where it is my right and my choice to discontinue treatment. That is something I have realized is extremely important.  For me the choice is to fight, but in context I had 50% of my kidneys stolen by medical error and 36 years ago when i was a baby, so with no other medical issues the choice is easier.

I do respect however those that suffer far greater than I do as this disease does quite often come with many other issues.  Doctors try to be sympathetic but the reality is that it can be a hard disease to manage.

In my country the right to refuse treatment or stop applying it is respected, albeit there are processes to go through.  It is not considered the big 'S' when a machine is maintaining life and without that machine life cannot continue.

I do also realize the US is in the grip of religious devotees which would naturally object to my opinions. 

Thank goodness for "real" separation of church and state that exists here, and for choices that allows.

[amanda100wilson]

 Ianch, it is perfectly acceptable for someone to stop dialysis in US. We sign a bundle of paperwork each year.  Within this is a sheet that we sign that states that we can stop dialysis at any time.

[AntNZ]

I don't think it is, to be honest. I had a friend who refused treatment after his transplant failed when he was 19. A lot of people argued that he committed suicide but what I said to those people was "you try living through what he has. I don't blame him. He had a rough life and felt he gave it his all. I think he was very brave."
And I still think that. I don't think that will change.

[Krisna]

I don't think it is but my family does!  And my kidney doctor does too!  And I would never do this.  I've fought too long and hard to live as long as I have!  In November it will be 34 yrs since I was diagnosed with ESRD!  And the doctors told my parents I wouldn't live past age 30.  I'm 41 yrs old and will be 42 in January!  And I'm pretty healthy considering.

I had an aunt who refused treatment.  And a friends' father who quit after a few treatments.  It's not for everyone.  And I considered it after I was refused another transplant.  I've been on hemo dialysis since Sept. 6, 2002 and there is only one way off for me!  And I cannot do PD because I have mesh holding my abdominal muscle together.  And a lot of scar tissue.  I've had too many surgeries!

[Rerun]

I'm just so tired of this.  It is hard to get fluid off me at dialysis.  A whole 8 hours and they can't remove 1 liter?  I have to sweat the rest off in my hot car.  Fall is just around the corner.  Then I may have to join the YMCA because they have a sauna.  I can't see anymore to drive so how will I get there.  I don't want to do this anymore. I don't.

[Big E]

Rerun, you sound so discouraged...I hope this is only temporary. Maybe you don't need more than a liter taken off--do you feel OK afterwards?