A Way Out

In this essay, the author describes the course of a patient in the end-stage renal program who has been receiving hemodialysis for 6 years and then makes the decision, while of competent mind, to withdraw from dialysis to end his life. The author, the patient's personal nephrologist, describes how he explained to the patient his options in the context of advanced medical directives and durable power of attorney for health care. The patient's last day of life is remembered in first-person narrative by his physician and the patient's wife. In this anecdotal account, persons receiving dialysis are singled out as unique in their ability to apply issues pertaining to their right to die.

What do chronic kidney failure, hypertension, degenerative arthritis, limited mobility, memory loss, hemodialysis, and 76 years of age have in common? Taken as a whole, nothing, but the dialysis part puts this melange into a unique situation: the ability to schedule one's own death.

I first met Dick 12 years ago. Dick had blood in his urine, small kidneys, and reduced kidney function. He had been dialyzed briefly in 1963 after an automobile accident and now had nephrosclerosis as well.

About 6 years after I assumed his care, Dick needed an inguinal hernia repaired. During that hospitalization, dehydration reduced his marginal renal function to the critical 10% level, and he was to receive dialysis forever.

He began coming to the outpatient facility three times a week for 4 hours each time. He had been an 18-hole, three-times-a-week golfer before dialysis and after a period of stabilization, was back golfing. He used his time on the machine wisely. He was a reader. In this way for 6 …