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Tuesday, June 27, 2017

Dialysis: A life saving machine

A 70 year old diabetic lady, hitherto active and leading a normal lifestyle, is admitted in the Intensive care with sudden difficulty in breathing since 2 days. After running a few tests, she is diagnosed with Acute kidney failure because of an infection in her urine. She has been advised an urgent lifesaving dialysis but her relatives outright refuse to go ahead with it. Their concern is that once started, she would require dialysis on a regular and lifelong basis. 
To convince someone for dialysis remains one of the commonest challenges faced by Internists and Nephrologists. In a country where quacks sometimes decide the course of medical therapy, where pharmacists prescribe scheduled drugs and where relatives are in charge of the fate of patients, saving lives is becoming more and more difficult. 
What is dialysis? Simply put, it is an artificial kidney. Our kidneys normally function to remove the waste products through the urine. When there is a kidney failure, dialysis takes up the function of the natural kidney and cleanses the body with the help of a machine. 
Broadly put, our kidneys may fail in 2 ways: 
1. The healthy kidneys stop working suddenly due to a recent crisis event. 
2. The kidneys are gradually damaged over a long period of time. The body adjusts to this and maintains its milieu till a crisis develops and the kidneys fail.
                       
It is important to note that kidney failure occurs only when both kidneys fail to function. In both the above situations, dialysis may need to be done for the reasons mentioned above. Also, dialysis doesn't help in kidney recovery but it just substitutes for the failed kidneys. But, it needs to be emphasised here that in the first case, since the kidneys were healthy prior to the illness, dialysis is only for a short period of time while in the second case, dialysis could probably be a lifelong affair.                              That brings us to a few important questions. Shouldn't saving a life be the topmost worry on the minds of the near and dear ones rather than worrying about whether the dialysis will be a lifetime headache? Don't the relatives have any responsibility ethically and legally towards the patient? Is only the doctor answerable for a wrong decision taken for a patient? 


And in our 70 yr patient, who eventually died because she was denied a chance to live, can the relatives be tried in court for negligence and malpractice??

3 comments:

  1. Sir in my opinion Doctors shouldn't be held responsible for Relatives wrong Decisions or non cooperation

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  2. Ibrahim sakarwala28 June 2017 at 17:52

    Refusing an obvious procedure like dialysis for a Patient by his / her relatives which proves fatal later is a debatable issue .....first of all
    1- who gives the relative rights to choose the treatment plan and why ?
    2- is there a authority justifying the need and urgency of such a treatment.... apart (from the doctor)...
    3- As no one can say for sure that a particular treatment will or will not work ...this creates as much confusion as the question itself .
    4-its a universal truth that one thing that works of an individual may or may not work for others
    5- if according to the doctor ( as in the case of the lady ) dialysis would work=.. why was an option given in the first place?
    6- to avoid legal issues consent is required which categorically excuses the hospital and the entire team. But it also transfers undue responsibility to the relative who is incompetent to decide what is to be done ...
    7- in my opinion the right to decide a particular treatment should be taken from the patient itself as then the onus of responsibility and any litigation thereafter doesn't matter as consent of all issues is taken before hand .....just like in many western countries ....save my soul ....what ever it takes .....simple ....

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    Replies
    1. Thanks for the comment.
      A consent has to be taken for any procedure. Even though dialysis is life saving, there is no law in this country that says that a hospital can proceed without a relatives consent. Also, most of the times the patients are not in a position to decide and give consent. So in such cases, who will take the responsibility of a decision?

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