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Controversy About Dialysis for an Adolescent
Tyler Tate1,2, Aviva Goldberg3, Aaron Wightman1,2
1Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.
Pediatrics
|August 1, 2017
Summary
Adolescents on dialysis may choose to stop treatment, raising complex ethical and medical questions. This case explores a 17-year-old
Area of Science:
- Pediatric Nephrology
- Bioethics
- Palliative Care
Background:
- Discontinuation of dialysis is a frequent cause of death in patients undergoing treatment.
- Patient autonomy in treatment decisions is complex, especially for adolescents.
- Ethical dilemmas arise when competent adolescent patients refuse life-sustaining dialysis.
Observation:
- A 17-year-old patient on dialysis elected to discontinue treatment via her fistula.
- Alternative dialysis methods were deemed excessively risky by the medical team.
- This case highlights the complexities of end-of-life decisions in competent adolescent patients.
Findings:
- The case necessitates a multidisciplinary approach involving pediatric nephrology, bioethics, and palliative care.
- Discussions focused on respecting patient autonomy while ensuring medical safety and quality of life.
- Exploring various response strategies for the healthcare team is crucial.
Implications:
- Healthcare providers must carefully consider the ethical and clinical implications of adolescent-led dialysis discontinuation.
- Ethical frameworks and communication strategies are vital for supporting patients and families in such situations.
- This case underscores the need for specialized guidelines addressing end-of-life care for adolescents with chronic conditions.
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