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Hospital head approved surgeon's proposal to stop dialysis for kidney disease patients

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

TOKYO -- The director of a hospital here, where a woman with a kidney ailment died after a surgeon discontinued dialysis on her with her consent, has admitted that he approved the surgeon's proposal to stop such treatment.

"In ordinary medical practices, doctors offer various options for treatment," Takeshi Matsuyama, head of Fussa Hospital in the western Tokyo city of Fussa, said in an interview with the Mainichi Shimbun.

Sometime around 2014, the 50-year-old surgeon proposed to Matsuyama, who was then deputy head of the hospital, that patients should have the right to choose not to undergo dialysis, according to the director.

Based on their idea, the surgeon and a 55-year-old physician specializing in kidney diseases offered a choice between continuing and discontinuing dialysis to a then 44-year-old woman in August 2018. At the time, the hospital explained to the woman that discontinuing dialysis would lead to her death.

The woman signed a letter of intent to discontinue dialysis. The woman subsequently suggested her will to resume dialysis saying, "I'm wondering whether to retract the letter," but she died.

"We offered various options to her and she made her own decision. We confirmed her will on multiple occasions, so what we did is an appropriate medical practice," Matsuyama told the Mainichi.

The director said he did not receive any particular report from the surgeon on the discontinuation of dialysis for the woman, and learned of the woman's case after she died.

The hospital did not convene a meeting of its ethical committee, which has been set up on recommendations from the Japan Society for Dialysis Therapy (JSDT), to discuss her case on the grounds that its discontinuation of dialysis was "part of ordinary medical practices," Matsuyama said in the interview.

"About 200 to 300 patients die at our hospital every year. It's unrealistic to convene a panel meeting on each of their cases," he said.

Moreover, the hospital also offered the option not to undergo dialysis to 149 patients with kidney ailments who were not terminally ill between April 2013 and March 2017, a practice that deviates from JSDT guidelines, and 20 of them who chose that option have passed away.

However, the director defended the hospital's practice. "It's necessary to have a choice of not conducting dialysis from the beginning. Other medical institutions may publicly say, 'We don't have an option not to perform such a therapy, but all medical experts who regularly contact patients know it's an option," Matsuyama said.

Furthermore, the hospital director called into question the ethicality of treatment aimed solely at prolonging patients' lives.

"There are patients who are unconscious and can't express their will at all. Gastric fistula and artificial respiration can technically prolong patients' lives. Such treatments cost a considerable amount of money. The question is whether such treatments should be justifiable," Matsuyama said.

"I hope that (the revelations of the hospital's discontinuation of dialysis) will be an opportunity to consider whether dialysis and other treatments aimed solely at prolonging patients' lives under any circumstances are ethically right," said the director.

(By Hidenori Yazawa and Yoshihiko Saito, Lifestyle News Department)

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