Table 1.

Appropriate situations for withholding or withdrawing dialysis

  • A fully informed patient with decision-making capacity who refuses dialysis or asks that dialysis be discontinued.

  • A patient who does not currently possess decision-making capacity but previously indicated refusal of dialysis in an oral or written advance directive.

  • A patient who does not currently possess decision-making capacity and whose properly appointed legal agent refuses dialysis or asks that dialysis be discontinued.

  • A patient who has irreversible, profound neurological impairment such that he or she lacks signs of thought, sensation, purposeful behavior, and awareness of self and environment.

  • Adapted from Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis (5).