Competent patients, incompetent decisions

Ann Intern Med. 1995 Dec 1;123(11):878-81. doi: 10.7326/0003-4819-123-11-199512010-00011.


We describe the epidemiologic aspects of dialysis withdrawal, the role of patient autonomy and of medical beneficence in the decision to discontinue dialysis, and the conditions under which limits may be placed on patient autonomy. A case is presented that provides insight into the issues involved in making such decisions and that should provoke further discussion on the role of "medical guidelines" for dialysis refusal and withdrawal.

MeSH terms

  • Beneficence
  • Carcinoma, Transitional Cell / complications
  • Decision Making*
  • Dissent and Disputes
  • Group Processes
  • Humans
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / therapy
  • Medical Futility*
  • Palliative Care
  • Patient Advocacy*
  • Personal Autonomy*
  • Renal Dialysis
  • Resource Allocation
  • Urinary Bladder Neoplasms / complications
  • Withholding Treatment*