BOSTON — People gravely ill with kidney failure often choose to end their lives by stopping dialysis treatment, and these little-publicized deaths are likely to become even more common, says a study to be released today in the New England Journal of Medicine.
Researchers surveyed a large dialysis program and found that halting the therapy accounted for 22% of the deaths among its patients.
"The chart notes describing how people dealt with the problems of terminating treatment clearly showed the agony and difficulty for everyone involved," they wrote. "This is as it should be. If such decisions are ever made quickly or easily, patients and society should indeed worry over what goes on inside hospitals."
Decisions on Treatment
Decisions to withhold or stop life-support treatment for gravely ill patients are common in hospitals. But they are seldom publicized except in rare instances when courts become involved, said the study conducted by Drs. Steven Neu and Carl M. Kjellstrand of the Hennepin County Medical Center in Minneapolis.
The new study demonstrates how commonplace these actions are among dialysis patients, who are often elderly and afflicted with multiple complications.
Dialysis purifies the blood and is essential for people whose kidneys have failed because of severe diabetes or other disease. Without dialysis, they inevitably die, usually within a few days.
The researchers reviewed the cases of 1,766 people who started dialysis between 1966 and 1983 at the medical center's Regional Kidney Disease Program. The program provides dialysis for most of Minnesota, North Dakota and South Dakota.
Patients' Own Decisions
Dialysis was discontinued for 155, or 9%, of the patients, and its halt accounted for nearly a fourth of all deaths.
Half of them were mentally competent and made their own decisions to stop dialysis. More than a third of them had suffered new medical complications just before the decisions.
The rest of the patients could not decide for themselves because they were in comas or suffered dementia, stroke damage or other brain disorders. For about three-fourths of these patients, doctors suggested to their families that treatment be stopped, while for the rest the families took the initiative.
New medical complications preceded the decision to stop treatment in all of the mentally incompetent patients.