Abstract
Withdrawal from Dialysis in Germany
Recommendations: (1) The essential basis for withdrawal from dialysis is the will of the patient and his consent. (2) The competent patient has the right to disagree with treatment. The patient is competent when he is able to judge the meaning, the extent, and the importance of his decision. (3) The physician must follow the written advance directive. (4) If a person has power of attorney for health care, that person has the power to decide for the mentally incompetent or unconscious patient according to the written advance directive. If there is no written advance directive, the surrogate and the physician have to explore and follow the patient's presumed will. (5) If there is an obvious discrepancy between the wish not to be treated and the patient's sickness, then the physician should involve a psychiatrist. (6) If the patient is near death, then prolongation of life by intensifying treatment could hurt individual dignity. The physician should stop the treatment, such as dialysis. The patient is near death if the patient would never be able to communicate with the environment and would die without the application of medical care. (7) If there is no written advance directive or a legal surrogate resp., then the physician has to stop treatment in the case of an unfavorable prognosis of the sickness and support for the diagnosis by a second physician. (8) If the physician wants to continue the life-sustaining treatment, but the surrogate does not agree, then that person has to obtain further consent by the court. (9) If the physician decides in agreement with the surrogate to stop the treatment because of the unfavorable prognosis, then there is no need for consent by the court. (10) If the physician wants to stop the life-sustaining treatment, but the surrogate wants continuation of the treatment, then the physician has the right to stop the treatment in patients with an unfavorable prognosis without the involvement of the surrogate or the court. During the process of dying, respecting the patient's dignity is of supreme importance. Even if life-sustaining procedures are withdrawn, the physician must assist the patient if there is any suffering such as pain or shortness of breath. Nursing care must be performed until the patient's death.