Dialysis is a medical procedure that takes over the function of failing kidneys, filtering waste products and excess fluid from the blood to sustain life. The decision to discontinue this treatment is one of the most profound choices a patient or family can face. It is a deeply personal and medically accepted option that shifts the focus of care from prolonging life to maximizing comfort and quality of life. Stopping dialysis is a valid choice that acknowledges the burdens of chronic treatment when the benefits no longer align with a patient’s goals.
When Dialysis Becomes Medically Burdensome
The decision to stop dialysis is often considered when the therapy becomes a source of suffering or when its ability to improve the patient’s quality of life diminishes substantially. For many patients, the physical and emotional toll of the regular treatment schedule, dietary restrictions, and repeated hospitalizations eventually outweigh the survival benefit. This is particularly true for individuals with irreversible co-morbidities that complicate their overall health status.
A patient may be considered to have “failure to thrive” despite dialysis when they experience a severe and persistent decline in function and nutritional status. This clinical syndrome is commonly observed in patients with advanced co-existing conditions such as severe heart failure, metastatic cancer, or advanced cognitive impairment like dementia.
The stress of the dialysis procedure—including blood pressure fluctuations, vascular access issues, and the time commitment—can make the remaining period of life stressful or painful. The care team assesses whether the burden of continuing the treatment is greater than the expected benefit of prolonged survival, leading to comfort-focused care.
Understanding Patient Rights and Refusal of Treatment
The foundation of the decision to withdraw from dialysis is the principle of patient autonomy, which grants every competent individual the right to refuse or withdraw any medical treatment, regardless of its life-sustaining nature. This right is not contingent on prognosis; a patient may stop treatment even if the medical team believes it would prolong their life. The ability to make this choice depends on the patient having medical capacity, meaning they can understand the nature of their illness, the purpose of dialysis, and the consequences of stopping the treatment.
If a patient lacks the capacity to make this choice, the decision-making authority transfers to a legally designated surrogate, such as a healthcare Power of Attorney or guardian. This surrogate must act according to the patient’s previously expressed wishes, which are often documented in an advance directive or living will. Stopping dialysis is uniformly considered a withdrawal of life-sustaining treatment and is not legally or ethically classified as suicide. The underlying cause of death is recognized as the progression of the end-stage kidney disease, not the patient’s decision to refuse treatment.
Care and Comfort After Discontinuation
Once the decision to discontinue dialysis is made, the focus of care shifts to palliative care or hospice, with the primary goal of managing symptoms and ensuring comfort and dignity. Palliative care teams specialize in addressing the symptoms that arise when waste products and fluid begin to accumulate. This focused support ensures the patient receives continuous care for their final period of life.
A major symptom that emerges is shortness of breath, caused by fluid overload in the lungs due to the lack of filtration. This is managed with medications like opioids and diuretics, and comfort measures such as supplemental oxygen and specific positioning.
Pain management is also a primary concern. While certain pain medications are carefully dosed due to their accumulation in kidney failure, alternatives like fentanyl or buprenorphine may be used, or the dosages of common medications like morphine are closely monitored.
The care plan also addresses other distressing symptoms such as nausea, treated with anti-nausea medications, and persistent itching caused by uremia. The goal is to provide a comprehensive approach that controls physical discomfort, allowing the patient to remain as alert and engaged as possible with their loved ones.
Expected Physical Changes and Timeline
Following the final dialysis treatment, the body begins to accumulate fluid, electrolytes, and metabolic waste products. This buildup of toxins, known as uremia, is the physiological process that leads to a decline in function. The patient will experience increasing fatigue, weakness, and drowsiness, which eventually progresses into unconsciousness.
Fluid retention is a noticeable change, leading to swelling and contributing to shortness of breath.
The timeline for survival after stopping dialysis varies significantly, depending on the patient’s overall health, residual kidney function, and co-existing medical conditions. Most patients with minimal to no remaining function live for a few days to two weeks. Individuals with some residual kidney function may survive for a few weeks, and in rare cases, up to a month.