Psychosomatics 1993; 34:395-401
Copyright © 1993 by Academy of Psychosomatic Medicine
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ORIGINAL RESEARCH REPORTS |
Patient attitudes and psychological considerations in dialysis discontinuation
LM Cohen, M Germain, A Woods, ED Gilman and JD McCue
Department of Psychiatry, Baystate Medical Center, Springfield, MA 01199.
The authors surveyed 36 adult patients who were maintained with chronic
renal dialysis concerning their attitudes about dialysis discontinuation.
Few subjects reported having ever considered stopping the life-support
treatment. When asked to consider 12 hypothetical scenarios in which they
might consider stopping treatment (e.g., onset of dementia or blindness),
most subjects would still not consider discontinuation. Consideration of
dialysis discontinuation was directly correlated with the patient's
educational level. Follow-up after 1 year underscored the substantial
differences between the responses the subjects gave to the 12 hypothetical
scenarios and their real-life responses when they were later faced with
decisions to actually terminate treatment. Psychiatrists have an
opportunity to participate in the complex clinical and ethical decisions
associated with advance directives and patients' right to refuse
life-support treatment.
