Conneen S, Tzamaloukas A H, Adler K, Keller L K, Bordenave K, Murata G H
Medical Ethics Committee, Renal Section, Veterans Affairs Medical Center, Albuquerque, NM, USA.
Dial Transplant. 1998 Apr;27(4):200, 202-4.
Since 1991, death following withdrawal from dialysis has increased greatly in our dialysis unit. This report is based on our observations of those patients who followed that course. Four types of patients who withdrew from dialysis were identified: those with a terminal illness, demented patients, those with a progressive disability, and those who had no serious medical problem other than end-stage renal failure. We analyzed the risk factors for withdrawal and attempted to define the ethical principles involved in each patient category. The authors conclude that although the decision of a competent patient to stop dialysis must be honored, some of those deaths might be preventable if patients on chronic dialysis are prospectively followed and treated by those who are expert in the behavior of patients with chronic illness.
自1991年以来，我们透析单位中停止透析后的死亡人数大幅增加。本报告基于我们对那些遵循该病程的患者的观察。确定了四类停止透析的患者：患有晚期疾病的患者、痴呆患者、患有进行性残疾的患者以及除终末期肾衰竭外没有严重医疗问题的患者。我们分析了停止透析的风险因素，并试图确定涉及每个患者类别的伦理原则。作者得出结论，尽管必须尊重有行为能力的患者停止透析的决定，但如果对长期透析患者进行前瞻性跟踪并由慢性病患者行为方面的专家进行治疗，其中一些死亡可能是可以预防的。
