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Docs increasingly grew sure in giving option to stop dialysis, 2 new deaths confirmed

Fussa Hospital is pictured here in Fussa, Tokyo, on March 6, 2019. (Mainichi/Yuki Miyatake)

TOKYO -- Two more patients were found to have died after agreeing to the option of discontinuing dialysis offered by a surgeon at a public hospital in the western Tokyo suburb of Fussa since around 2014.

This brings the number of patients who stopped dialysis after being given the option to do so at Fussa Hospital to five, of whom four have been confirmed to have subsequently died, including a 44-year-old woman who died in August 2018. Separate from these cases, 20 non-late-stage patients at the hospital died after refusing to undergo dialysis in the first place between April 2013 and March 2017.

None of the five patients who stopped dialysis were in the late stages of their illnesses, and according to the 50-year-old surgeon, could have lived years if they had continued dialysis.

According to the surgeon and a 55-year-old kidney specialist at the hospital, around 2014, a woman in her 80s was brought in unconscious due to kidney failure, to which they responded by providing emergency treatment. When the woman regained consciousness, she asked that she be taken off dialysis, so the surgeon explained to the woman that going off dialysis would lead to her death. After obtaining the consent of both the patient and her family, the patient was taken off dialysis the next day. She then went home, where she died.

The surgeon and the kidney specialist recalled that they were surprised. At first, they had not been enthusiastic about stopping dialysis treatment, they said. But coming round to the thinking that leaving treatment decisions up to the doctor without the patient truly understanding the treatment was "not proper medical treatment," they decided to present patients with the option of continuing or discontinuing treatment.

They first presented the option to stop dialysis to a patient around 2015. They told a 55-year-old man who had been undergoing dialysis for two months that he had the freedom to continue or discontinue dialysis. The man told them he would halt the treatment, and went home. He had been put on a restricted diet for his condition, but he is said to have eaten a steak before his death, and the doctors were thanked by his family.

Last year, the doctors developed more confidence and more specificity in presenting the option of discontinuing dialysis to their patients. To a woman in her 80s, who had a pre-existing chronic condition and whose arteriovenous shunt -- where the needle for dialysis treatments is inserted -- was causing problems, the surgeon presented various options, including that to discontinue dialysis and said, "It's time to think about what to do." She and her family consented to stopping dialysis, and the woman died approximately two weeks later.

Asked by a male patient in his 30s how long he would have to undergo treatment before he got better, the surgeon not only explained that he would have to receive dialysis for the rest of his life, but also presented the option of stopping dialysis. The man is said to have told the doctor, "I finally understand. I don't see the need or the value in continuing dialysis," and returned to the clinic from which he was referred to Fussa Hospital. What happened to the man after that is unknown.

(Japanese original by Yoshihiko Saito and Keisuke Umeda, Lifestyle News Department)

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