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Withdrawal of dialysis recommendations

•Withdrawal from dialysis is ethically and clinically acceptable after a process
of shared decision making. It is incumbent upon all providers caring for a
patient contemplating stopping dialysis to address potentially remedial factors
contributing to the decision such as depression or other symptoms such as
pain as well as potentially reversible social factors.

•Situations in which it is appropriate to withdraw dialysis include the following:

Patients with decision-making capacity, who being fully informed and making
voluntary choices, refuse dialysis or request that dialysis be discontinued.

○Patients who no longer possess decision-making capacity who have
previously indicated refusal of dialysis through appropriate ACP.

○Patients who no longer possess decision-making capacity and whose properly
appointed legal agents/surrogates refuse dialysis or request that it be
discontinued.

○Patients with irreversible, profound neurological impairment such that they
lack signs of thought, sensation, purposeful behavior, and awareness of self and
environment.


•Ensuring access to appropriate supportive and/or hospice care is an integral
part of the care following a decision to withdraw dialysis.