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Kidney disease patient dies after doctor offered choice to end dialysis treatment

Fussa Hospital is seen in Fussa, Tokyo, in this March 6, 2019 photo. (Mainichi/Yuki Miyatake)

TOKYO -- A 44-year-old kidney disease patient died a week after her dialysis treatment was terminated by a doctor who offered her such an option, the Mainichi Shimbun has learned.

The woman, a resident of Tokyo, died in August last year after a 50-year-old surgeon at Fussa Hospital in the capital's suburban city of Fussa presented the option of discontinuing her dialysis treatment and she chose that path.

According to the hospital, two other patients -- a man in his 30s and another man aged 55 -- also had their dialyses terminated, and the 55-year-old later died.

A set of guidelines issued by the Japanese Society for Dialysis Therapy allows for withdrawal of dialysis only under limited circumstances, such as the patient's condition being extremely poor. As the incidents at the hospital deviate from those guidelines, the Tokyo Metropolitan Government, which oversees the hospital, launched an on-site inspection of the facility on March 6 in accordance with the Medical Care Act.

The surgeon, however, insists that "Patients should be granted the right not to undergo dialysis treatment."

According to the hospital, the woman used to receive dialysis at a clinic near her home for about five years. After her blood shunt was clogged, making it impossible to inject a syringe for blood purification, she visited the Fussa Hospital's medical center specializing in kidney disease treatment on Aug. 9, 2018. The surgeon in question offered her an alternative therapy to insert a tube near her neck, alongside an option to terminate her dialysis, saying such a treatment could "lead directly to death."

The woman opted for discontinuing treatment, saying, "I don't want to receive dialysis anymore." The surgeon called in her 51-year-old husband to confirm her decision, and the woman signed a letter of confirmation. Her dialysis was accordingly terminated.

A 55-year-old kidney disease physician at the medical center quoted the woman as saying, "I won't get dialysis. I want to see the end of my life at Fussa Hospital." She was admitted to the facility on Aug. 14 last year after complaining of difficulties breathing.

The following day, however, she told her husband, "I will retract (my decision) to suspend dialysis," according to the spouse. The husband then asked the surgeon to resume her dialysis.

The surgeon also said, "I heard her say several times, 'I might restart dialysis if it (discontinuing treatment) is this painful.'" However, he only gave her pain relief treatment. The woman died shortly past 5 p.m. on Aug. 16.

The surgeon justified his actions, saying, "I attached weight to her firm will (to discontinue treatment) from when she was sane." The doctor said she could have lived for another four years had the treatment not been cut off.

"Patients are suffering as a result of futile and one-sided life-prolonging measures, as dialysis is introduced without sufficiently confirming their will. The right not to undergo treatment should be granted," the surgeon said.

The guidelines released by the Japanese Society for Dialysis Therapy in 2014 limit discontinuation of dialysis to cases where the patient's general condition is extremely poor and where such a treatment carries a high risk of posing serious harm to the patient's life.

Kanji Shishido, executive director of the Japanese Association of Dialysis Physicians, criticized the surgeon's action, stating, "The surgeon guided the patient to suicide. Such actions run counter to medical ethics and are unrelated to medical care."

The surgeon in question, however, argues that the female patient was "in the terminal phase."

The Ministry of Health, Labor and Welfare's guidelines for treatment of terminally ill patients, which were revised in March last year, call for medical workers to exercise caution in deciding discontinuation of patients' treatment based on reasonability from a medical perspective and accept changes in the patient's will.

In a related development, the Japanese Society for Dialysis Therapy on March 7 decided to launch a fact-finding committee to look into the Fussa Hospital case. The panel, headed by society director Ken Tsuchiya, a professor at Tokyo Women's Medical University, has already interviewed the 55-year-old kidney physician and asked the hospital director to comply with the investigation, according to society head Hidetomo Nakamoto. The physician is a member of the society.

The panel looks to probe whether the hospital responded to the woman's case properly in light of the society's 2014 guidelines as well as the health ministry's guidelines for end of life care.

The society will also examine the case at an ethics panel involving external experts and map out a policy on how to respond to the case as an organization. The group will also consider revising its own guidelines.

"It is a critical case concerning the life or death of a human being. We would like to decide on our response after hearing various opinions," Nakamoto said.

Meanwhile, Fussa Mayor Ikuo Kato, who is responsible for supervising the hospital, said on March 7, "It is difficult to determine whether (the hospital's response) was good as it was a matter of the doctor's judgment." The mayor will discuss a response with hospital officials shortly.

The Fussa Hospital is run by Fussa Byoin Kumiai, an association comprising the Fussa, Hamura and Mizuho municipal governments.

(Japanese original by Yoshihiko Saito, Lifestyle News Department)

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