| [ Summary ] |
Approximately 50 % of hospitals had experienced a decision to discontinue or not initiate dialysis. Approximately 90 % of those patients were elderly patients, approximately 50 % had been diagnosed with dementia, and approximately 8 % had initiated and re-initiated dialysis. A few decisions regarding forgoing dialysis were not in compliance with the guidelines pertaining to shared decision-making. Physicians specialized in dialysis care are required to attend an educational session/seminar on ethics prior to applying to take their board examination or renewing their license. They must also regularly confirm the patient's wishes even after the decision is made. These recommendations pertain to terminal patients. Therefore, when a non-terminal patient refuses dialysis, the medical team must help such patients to make the best choice by providing sufficient information, discussing the situation thoroughly and following the patient's decision-making process. Most hospitals recognize the importance of advance directives, and these should be more widely adopted in future. |