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Kidney patients' relatives perplexed by doctor's offer to cease dialysis

In this Nov. 30, 2017 file photo, a patient is seen receiving a dialysis treatment in Nagasaki. (Mainichi/Eriko Hori)

TOKYO -- Relatives of two people with kidney illnesses say they were perplexed when a doctor at Fussa Hospital here offered the patients the option to cease dialysis treatments.

One relative said it felt like the doctor had told them to give up on their loved one's life.

A woman in her 80s had been receiving peritoneal dialysis at the public hospital in the western Tokyo city of Fussa, according to those familiar with the matter. In peritoneal dialysis, a cleansing fluid, or dialysate, is circulated through a tube inside the abdominal cavity. The fluid extracts waste products from the blood running through vessels in the peritoneum -- the membrane that lines the inside of the abdomen -- before it is drawn back out of the body and disposed of.

However, the woman became unable to undergo the treatment in March 2018 because of problems with the abdominal membrane. A 50-year-old surgeon told one of the woman's relatives that she had a choice between getting dialysis through a catheter inserted into an area near her neck, or discontinuing the treatment.

"I felt that I was told she 'shouldn't continue dialysis any further because it costs taxpayers a lot of money,' and that I 'should give up hope that she will continue to live,'" the relative said.

After all, the patient continued dialysis through a neck line. However, the relative said they were so shocked at the doctor's proposition to halt treatment that they did not tell the woman about it.

The doctor also offered the choice to discontinue dialysis to another patient in November last year, a man in his 70s who has been undergoing the treatment for 40-plus years. The patient was presented the option when he visited the hospital to have an arteriovenous shunt -- where the needle for dialysis treatments is inserted -- examined.

"Do you intend to continue dialysis? When the shunt is rendered unusable in the future, you have the choice of discontinuing dialysis," the surgeon was quoted as telling the man.

The man's wife said she was surprised at the suggestion. "We'd never been told such a thing. I wondered whether medical treatment had changed," she recalled. The man said, "I thought I couldn't make the decision on my own" because he had a family.

The surgeon said that they always offer the option to discontinue dialysis to patients in cases where there arises problems with shunts or it otherwise becomes difficult to continue standard treatment methods.

"The decision to reject the option (of continued dialysis treatment) should be accepted," they added. The doctor then insisted that patients with kidney failure should be allowed to choose their treatment methods after understanding that kidney failure is incurable, and that dialysis is a form of life support.

"Patients would be shocked if they weren't informed of all the appropriate choices. They can calmly think about the matter as long as they are informed of the options from the beginning," the doctor said, adding, "However, it's natural for some patients to feel that their doctors have given up on treating them."

This surgeon was the same doctor who gave a 44-year-old woman the choice of opting out of dialysis in August of last year. She died shortly thereafter.

(Japanese original by Yoshihiko Saito, Lifestyle News Department)

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