How often do you dialysis nurses/MDs see patients want to stop their hemodialyis? What do you do with confused patients?? What if their confusion does not resolve?? Do families have the right to ask that their hemodialyis be stopped especially if they have been given durable power of attorney? What if the confusion gets better, the patient goes home with family, is it right to ask the patient who may not be totally competent if they understand that hemodialsyis is a form of life support and not just a treatment. Is it right to ask the patient at what point he would agree that his dialyis should be stopped? If a patient see that his quality of life is decreasing what have you seen familie do?

We have had two patients withdraw from dialysis this month. This is usually for us, as we ususally don't have 1 per year. The first patient was completely competent but had many, many complications from her diabetes, infections, etc. and she didn't want any more. We supported the decision and hosptialized her with a morphine drip.
The other patient was care for by her husband. She was in a condition that assessing her competencey would have been very difficult. Her husband and sons made the decision. We offered hospice but the husband declined and she was hospitalized.