No Dialysis Or Transplant — Comfort Care
“I have always regarded the ability to choose the time, the hour, the place and the manner of our death as the greatest privilege that dialysis gives us. And it is unique to us. So I’m grabbing the chance with both hands. I wish I had a third to embrace it even harder. I’ve had a great life. Thoroughly enjoyed it, all 80 years of it. Even the last 10 years on dialysis. Now it’s time to call quits, to take the Last Train home, to leave while the going’s good.” Bob H.
Dialysis does not always help people live longer. For those 80 years old or older and frail or with other illnesses, dialysis did not extend life. For some, the best way to treat kidney failure may be to let nature take its course. We call this “comfort care.” It may also be called “conservative management with no dialysis.”
Choosing comfort care may make sense if:
- There is a lot of pain (such as from cancer) that can’t be helped.
- More than one severe chronic disease is present at the same time.
- Quality of life is poor, with little hope that it will get better.
- Someone does not know what is going on or fights the treatment (as with dementia).
Comfort care does not mean “doing nothing.” It is an active course of treatment, with:
- Palliative Care. From the word “to cloak,” palliative care offers help to cope with a chronic disease and boost quality of life. It does not shorten life or lengthen it. The patient will have clinic visits. In fact, a whole team of healthcare staff will seek ways to relieve pain, symptoms (like shortness of breath or sleep problems), and stress. Physical therapy, massage, medicines, diet, and other techniques may be used.
- Hospice Care. Hospice includes all of the above—plus counseling and spiritual aid. Hospice staff will help someone who is dying and his or her loved ones. Services can take place in the home, in a hospital, or in a hospice center. To qualify for hospice, a doctor must write a letter that says someone has six months or less to live. Medicare will pay for hospice care.
If comfort care is something that you want, talk with your loved ones. Be sure they know how you feel, and why, and what your wishes are. Expect that they will feel sad and may try to change your mind. It may help to have a counselor or chaplain help you talk with them. Most religions view saying no to dialysis as letting natural death occur—not as suicide.
A natural death from kidney failure does not hurt. As toxins build up in your blood, you will start to feel sleepy. Water building up in your blood can make it hard to breathe. You may want to have treatments that remove water but not toxins, to make you comfortable. An Advance Directive is a way to say what you do and do not want for your healthcare in case you are not able to speak for yourself. All adults need to have one. A Healthcare Power of Attorney form lets you choose someone who can speak for you for healthcare decisions. To get these forms, go to a lawyer, look on the Internet, or ask your doctor’s office.
When you know that your time is limited, you can plan to spend time with people you care about. You can get your affairs in order. Be sure that your loved ones know where to find key papers, like deeds, bank accounts, and insurance plans. You may want to gather up photos or write letters, and share what you would like for a memorial service. You can give cherished items away and see the faces of those you give them to. You can say goodbye.
“I imagine that this is the beginning of the end. That from now on I will grow sleepier and sleepier day by day until I finally lapse into a coma. I still feel as relaxed about it as before… I would recommend it to anybody thinking of trying death for the first time.” Bob H.