Withdrawal from dialysis: ethical issues.

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.