[Dialysis as coercive treatment]

Carrying out dialysis against a patient's will poses specific legal and ethical problems. Decisions have to be made under time pressure, there is often an immediate threat to life, the intervention is rather difficult to carry out against a patient's will, and the same dilemma repeats itself continuously within some days.

We report on a 45-year-old man with moderate dementia due to hypertensive encephalopathy who was involuntarily admitted to a psychiatric hospital by a court order because of his refusal of dialysis.

Dialysis could be carried out with moderate coercion in a general hospital and was subsequently accepted by the patient after two treatments. The protest of the psychiatric hospital against the obligation to provide dialysis by coercion was accepted by the superior court some weeks after discharge of the patient, because dialysis is not provided in the psychiatric hospital.

Though a good outcome could be achieved in this particular case, many questions remain unclear concerning the feasibility of dialysis under coercion in cases of patients with impaired capacity to give informed consent, and the legal responsibility for the realization of court orders.