Competent patients, incompetent decisions

Article Abstract:

Both physician and patient concerns may need to be considered when making decisions regarding withdrawal of dialysis. Discontinuing dialysis for patients whose kidneys do not function usually results in death in about eight days. A 70-year-old dialysis patient in poor health stated her wish to continue dialysis, against the advice of the hospital staff. They seemed to think the use of dialysis for her was a waste of resources and time. Certain guidelines exist for withdrawal of dialysis, and include whether the patient is mentally competent to decide to continue dialysis. This patient was judged to be mentally competent. Hospital staff eventually decided to discontinue dialysis for the patient after she developed cancer which spread throughout the pelvis.

Analysis, Medical care decision-making authority (Law), Medical care decision making authority (Law), Hemodialysis

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The care of dying patients

Article Abstract:

Attitudes about death among both doctors and patients and society's expectations of the medical community need to change if patients are to have a reasonably painless and dignified death. Recent research has found that many patients die in a great deal of pain and anguish despite efforts to communicate a desire to die comfortably. Widespread belief that death is a failure may fuel the ambivalence patients and doctors feel to stay in control. Strategies to improve end-of-life experiences have included advance directives and increased use of hospice care. Future research may reveal other improvements to end-of-life care.

Editorial

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A letter from a patient's daughter

Article Abstract:

Hospitals need to develop and clarify their policies and procedures to honor patients' wishes in maintaining life artificially. An 87-year-old dying patient's daughter entrusted with the power of attorney for her mother's healthcare relates her experiences during the five days before her mother's death. Intensive care doctors persisted with life-prolonging measures despite the existence of a written living will, the advice of the daughter, and active resistance by the patient. Doctors trained to prolong life may not consider the quality of that resulting life and may overlook the wishes of the patient and the family.

Living wills

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