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Japan Dialysis Society to expand treatment rejection guidelines

Fussa Hospital, where a 44-year-old patient died after reportedly choosing to end her dialysis treatment, is seen in Fussa, western Tokyo, in this file photo taken from a Mainichi Shimbun helicopter. (Mainichi)

TOKYO -- The Japan Society for Dialysis Therapy (JSDT) indicated to its members on June 28 that it intends to expand its current guidelines on dialysis patients' right to refuse care -- an option currently limited to those receiving end-of-life treatment.

The announcement came at the 64th Annual Meeting of the JSDT in Yokohama, Kanagawa Prefecture, south of Tokyo. The society's chair, Hidetomo Nakamoto, a professor at Saitama Medical University, stated that "(the current guidelines) are unsuitable for the present state of healthcare. I want to propose measures that will help to protect caregivers."

The steps come in anticipation of further cases of patients outside of the present framework requesting an end to their dialysis, such as in August 2018 at the Fussa Hospital in Tokyo, when a 44-year-old female patient not in the terminal phase of her condition consented to ending dialysis treatment and subsequently died.

Processes to confirm patients' intentions, and how to cease treatment, will be drawn up by March 2020.

The present guidelines were created by the JSDT in 2014. Termination of dialysis is limited to end of life circumstances, such as if a patient's condition is extremely bad, or if dialysis treatment itself poses a danger to the patient's life.

In Japan's 1,407 institutions associated with the JSDT, 76.6% of cases in which dialysis treatment was discontinued or never started were carried out in accordance with the current guidelines. The results, which revealed just under a quarter of all dialysis discontinuation judgments are non-compliant, were uncovered in a survey carried out between 2016 and 2017 by JSDT board member Kazuyoshi Okada, deputy chief of Kawashima Hospital in Tokushima Prefecture.

Speaking at the annual meeting, Okada explained, "I want us to respect the decisions patients make for themselves."

A statement issued by the JSDT in May concluded that it supported Fussa Hospital's decision. It said it was right to respect the wishes of the patient, who is said to have felt strongly about discontinuing her treatment despite not being in an end-stage condition. However, a Mainichi Shimbun investigation into the case found no record of a final confirmation of her intention in her patient files.

Following an on-site inspection by the Tokyo Metropolitan Government, it was confirmed that of approximately 24 patients who died after ending dialysis or never undergoing it, evidence of written consent was not found in 21 cases.

While the JSDT will approve new measures allowing for ceasing treatment for patients who are not at the end of their lives, it is also expected introduce measures for leaving a written record of repeated explanations of the decision in patient files, plus rules on how to obtain written consent from patients.

(Japanese original by Go Kumagai, Lifestyle and Medical News Department)

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