| 特集名 | 透析患者の人生の最終段階への関わり方 | |
|---|---|---|
| 題名 | 透析差し控え・中止 (5) 腎専門病院における透析見合わせの現況―倫理委員会の意義について | |
| 発刊年月 | 2018年 09月 | |
| 著者 | 手島 和代 | 長崎腎病院 |
| 著者 | 原田 孝司 | 長崎腎病院 |
| 著者 | 舩越 哲 | 長崎腎病院 |
| 【 要旨 】 | 透析患者の終末期は非透析患者と大きく異なり，彼らがどう人生の最終段階を迎えるかは，「どう透析を終えるか」と強く結びついている．さらに超高齢者の末期腎不全が増加し透析導入の是非についても考えねばならず，2014年に「維持血液透析の開始と継続に関する意思決定プロセスについての提言」が日本透析医学会から発行され，透析中止・非導入についても指針が示されている． 当院では2008年から2018年現在に至るまで，14名において透析の中止・非導入を経験した．内訳は透析非導入が5例，透析の継続中止は9例，理由は認知症が7例，癌が4例などであった．当院ではたとえ患者・家族の意思が明確であっても，原則として全例を倫理委員会にて検討し，この問題に慎重に対応している． |
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| Theme | The management of the end of life in hemodialysis patients | |
|---|---|---|
| Title | Withholding and withdrawal of dialysis in nephrology hospital -- a role of ethics committee | |
| Author | Kazuyo Teshima | Nagasaki Kidney Hospital |
| Author | Takashi Harada | Nagasaki Kidney Hospital |
| Author | Satoshi Funakoshi | Nagasaki Kidney Hospital |
| [ Summary ] | End-of-life care for patients undergoing dialysis is notably different from that provided to the general population because how they prepare for impending death is strongly related to how smoothly they can quit maintenance dialysis. With a rapidly aging population and a greater number of elderly individuals in our society, withholding dialysis may need to be considered. Thus, the Japanese Society of Dialysis Treatment had established "Proposal for the Shared Decision-Making Process Regarding Initiation and Continuation of Maintenance Hemodialysis" in 2014, listing guidelines for withholding or withdrawing from dialysis. Between 2008 and 2018 we encountered 14 cases of withholding or withdrawing from dialysis at our hospital: 5 patients withheld and 9 withdrew from dialysis. Reasons for refusal to receive dialysis treatment (either by the patient or the family) included dementia in 7 patients and cancer in 4, in addition to other reasons. In our facility, we discussed ethical issues regarding the withholding or the withdrawing in our ethics committee even the will of the patients were clear. |
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