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Lrs497 Asked January 2020

How to let a 87 year old 5+ year dialysis patient know they have an option to stop treatment. Is it compassionate or wrong to do so?

He’s been on dialysis for at least 7 years. He is home bound due to mobility issues and only leaves the house via self-paid ambulance service (or due to 911 calls for any variety of issues). He is in constant pain and discomfort. He is losing his ability to safely do self transfers from chair to toilet or chair to chair/bed. He is becoming increasingly confused. I think a compassionate thing to do is remind him that he has a choice - not make the choice for him, but let him know that he can choose to stop at any time. My husband thinks he will only take it as a cue to go die. (Honestly, he might - - but he is suffering so much and there is no bright spot in the future. Quality of life will not improve.) Is my thinking completely wrong? Who would even have that conversation with him? This is my father in law and my husband is his only child. I do understand my husband’s hesitation, but I truly feel that there’s greater compassion in reminding him of what one doctor mentioned at least seven years ago, but even then I’m not even sure it was presented as too much of a choice. My father in law never was an independent thinker and always relied on what others “told him” to do.

JoAnn29 Jan 2020
I had two friends who chose to stop. One, S, was a juvenile diabetic. Her veins would collapse so reg dialysis was not an option. Other options were tried but eventually she went on Hospice. J had diabetes later in life. lost a leg and kidneys stopped functioning. He had over 600 treatments. He chose to die. Both were gone 2 weeks after stopping dialysis.

anonymous912123 Jan 2020
I was with my step father at one of his doctor's appointments. He has been on dialysis for almost 7 years, aside from this he has bladder cancer, heart issues, circulation issues and is in and out of the hospital on a regular basis. Finally, he is totally deaf.

The doctor did broach the subject as there is nothing more that can be done for the bladder cancer and heart issues. His response was that he wanted to live for another 3 years, he is 90, so the doctor prescribed more meds and off we went.

I would think that this conversation should be with his doctor, with your husband present.

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cwillie Jan 2020
I would be surprised if there wasn't somebody at his dialysis unit who is very experienced at having this kind of discussion, I would ask there first.

Grandma1954 Jan 2020
Not sure if this is a dad, grandpa or ?
Have you had previous discussions with this person about ..life..what they want done as far as treatments and things like that?
You could have someone from Hospice, and Palliative Care come and talk to this person and give them the options and what would result with the options.
This is a difficult discussion for many people and that is why there are family squabbles, and family divisions because one group thinks one way, the other the other all forgetting what would their loved one's decision have been had they voiced it, had they been asked.
My guess an 87 year old with other issues and dialysis for 7 years is probably tired of it all, in pain, frustrated that they can no longer do what they could maybe even 6 months or even a month ago.
Hospice Palliative care staff will detail what can be done, what will happen and the decision is for the 87 year old to make.
The kicker her is how "confused" is this person? Is he able to make a competent decision? Does anyone have POA for health and finances? If he is not legally competent this might not be a decision he can make and it would be left to his POA

Daughterof1930 Jan 2020
This is a conversation that should happen between doctor and patient. Schedule an appointment with his doctor, let the doctor know ahead of the appointment that the family would like this to be discussed in the most compassionate way possible, and then leave it between them. As daughter in law, if you step any further into it, it can only be bad for you

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