March 8th 2019
TOKYO — Twenty people died after a hospital here chose not to conduct dialysis treatment on them in accordance with their will, even though they were not terminally ill, those familiar with the matter said.
The revelations follow the disclosure of the death of a 44-year-old woman suffering from a kidney ailment after a doctor at the hospital offered the option of discontinuing dialysis and she complied.
The hospital’s practice of not performing the treatment from the beginning deviates from the Japanese Society for Dialysis Therapy’s 2014 guidelines, which stipulate medical institutions can do so only in cases where patients’ conditions are extremely poor or such a procedure is highly likely to endanger patients’ lives.
According to the kidney treatment center of Fussa Hospital in the western Tokyo city of Fussa, doctors uniformly offer the choice of whether to receive dialysis to patients with kidney illnesses that require dialysis or kidney transplants for survival, at the point at which the center finds that the patients cannot undergo kidney transplants.
Twenty of 149 patients who received examinations at the center between April 2013, when it was established, and March 2017, chose not to receive dialysis even though they were not terminally ill. They subsequently died.
Most of the 20 were 70 or older but two of them were in their 50s. A male patient in his 50s, who had disabilities because he had suffered a stroke when he was young, was quoted by the center as explaining that he did not want to cause trouble to his mother with whom he lived.
A 55-year-old kidney specialist at the center said they clearly explained to such patients that choosing not to receive dialysis would lead directly to death. If their families asked why the patients would choose to die when they could live if they received treatment, the doctor said the center urged the patients to convince their families of their decision.
A 50-year-old surgeon who tended to the 44-year-old woman and the 55-year-old kidney specialist have interpreted dialysis as symptomatic treatment.
“Doctors shouldn’t force painful symptomatic treatment on patients. There are cases in which families regret choosing dialysis for patients. We shouldn’t be providing perfunctory medical treatment. A time will come when it will be standard for doctors to confirm with the patients whether they want to undergo such a procedure,” one of the doctors said.
Kanji Shishido, executive director of the Japanese Society for Dialysis Physicians, pointed out that patients tend to be mentally unstable when they begin to receive dialysis.
“In many cases, patients cannot make appropriate judgment when they begin to receive the treatment because they are mentally unstable. Many patients say they feel better even though they were initially reluctant to undergo such a procedure. Uniformly choosing not to conduct dialysis (for those who do not want such therapy) could even lead patients to suicide,” he said.
Waseda University professor Katsunori Kai, who is well versed in medicine, said it is inappropriate to allow patients who are not in extremely serious conditions to choose not to receive dialysis.
“It’s possible for doctors to respect the will of patients who suffer pain from continuing to receive dialysis because of complications and who refuse to receive such a procedure. However, it is ethically inappropriate for doctors to allow patients who are not in such a condition to choose not to receive dialysis,” Kai said.