He is not depressed and not encephalopathic. What should you tell him?


#1

A 47 year old man with end-stage renal failure has asked you to stop his dialysis. The patient finally understands that he will die if he stops dialysis for more than a few days or weeks. He is not depressed and not encephalopathic. What should you tell him?

a.
“I need a court order first.”
b. “l
am sorry; I don’t feel comfortable doing that.”
c.
“I can’t do that. P\sician assisted suicide is not ethical.”
d. “I rvill stop when \ye get you a kidney transplant.”
e.
“You rvill f’eel better if I sedate you so that you stop disagreeing with me.”
f. 'Although I disagrce witl.r your decision, I will stop the dialysis."
g.
“I cannot do that. We already started dialysis. Now we have to continue.”
h. “Not until you pay your bill.”

Explanation:

(f) “Although I disagree with your decision, I will stop the dialysis.”
An adult with the capacity to undcrstand the effccts of his decisions (rn st()p ry
forn of therapy even if it rvill lead to his death. Stopping dialysis is not a form of physician assisted suicide or euthanasia. Eutltanasia mcans giving a medication that will
kill the patient. The primary clifference is one ofintent. Passive dying from stopping a
medical treatment is cntirely at the discretion of the patient provided that the person
is not acutely clepressed ancl suicidal. By dcfinition, a suicidal patient is decmed not
to be competent. This case specifically states that the patient is not depressed.
Although there may bc an emotiolal difference betwcen stopping therapy and ever
starting in the first placc, there is no legal difference. Therc is no ethical or lcgal difference betrveen withholding and withrlrawing a treatmcnt. All that matters is rhat
you are adhering to a competent adult’s clcar wishes for his own cire.
lf I am painting your house blue and halfivay through the job you insist that I paint
the house red, I must comply rvith your wishes. I can’t tell you,
“Sorry,
once I start to
paint, I don’t stop urtil thejob is clone. Your wishes are less important than mine.” It
is your housc. You can do what you want $'ith it.