Dialysis serves as a life-sustaining medical treatment for individuals whose kidneys can no longer function adequately. This procedure takes over the kidneys’ role in filtering waste products and excess fluid from the blood. When kidney function declines to less than 15% of normal, often referred to as end-stage renal disease (ESRD), dialysis becomes necessary to prevent the accumulation of toxins that would become fatal.
Immediate Physiological Consequences
Refusing dialysis leads to a rapid build-up of waste products, primarily urea, in the bloodstream, a condition known as uremia. This toxic accumulation quickly impacts bodily systems. Patients often experience profound fatigue, persistent nausea, and vomiting.
Fluid overload is another immediate consequence. Without dialysis, the body cannot excrete excess water, leading to swelling (edema) in the extremities like hands, ankles, and feet. This fluid can also accumulate in the lungs, causing shortness of breath. These immediate effects manifest within days to a few weeks, depending on the individual’s remaining kidney function and overall health.
Progression of Symptoms and Organ Failure
As kidney failure progresses without dialysis, symptoms escalate and severely affect major organ systems. The cardiovascular system is vulnerable, with fluid overload potentially leading to irregular heartbeats (arrhythmias) and fluid accumulation around the heart (pericardial effusion). High levels of potassium (hyperkalemia) can develop, which can cause a heart attack.
Neurological changes also become apparent, ranging from confusion and difficulty concentrating to seizures and eventually coma. These complications are ultimately fatal, with death typically occurring within a few days to several weeks.
Medical and Comfort Care
When an individual chooses to refuse dialysis, medical care shifts focus from life-prolonging treatments to palliative care, also known as comfort care. This approach aims to manage symptoms, alleviate pain, and enhance the patient’s quality of life. The goal is to ensure a peaceful and dignified end-of-life experience.
Palliative care includes managing symptoms such as nausea, pain, shortness of breath, and anxiety. Medications control these discomforts, ensuring the patient remains comfortable. Hospice care, a specialized form of palliative care, can be initiated, offering comprehensive support in the patient’s home, a hospice facility, or a hospital.
Patient Rights and Decision-Making
Individuals have the legal and ethical right to make informed decisions about their healthcare, including refusing life-sustaining treatment like dialysis. This principle is rooted in patient autonomy. Healthcare providers must ensure patients understand the potential consequences of their decisions before refusing treatment.
Advance directives, such as living wills or durable powers of attorney for healthcare, are legal documents allowing individuals to express wishes for future medical care if they become unable to communicate. These documents guide loved ones and medical professionals in respecting patient choices. Common reasons for refusing dialysis include concerns about quality of life, treatment burden, or personal beliefs.