Futility analysis of treatment prolongation in patients with end-stage chronic kidney disease from medical perception

Abstract

Introduction: chronic kidney disease is a pathology that reduces the expectancy and quality of life of patients. Doctors are primarily responsible for preserving the patient's life and are responsible for shared decision making. Objective: to analyze the perception of medical personnel regarding the prolongation of renal replacement treatment in patients with chronic kidney disease in the terminal phase in the dialysis unit at the General Teaching Hospital of Ambato, Ecuador. Method: a qualitative research was carried out, with a semi-structured interview that consisted of questions guided by the theory-hypothesis of the topic. The study sample was made up of doctors from the Dialysis Unit, responsible for the clinical management of patients with chronic kidney disease undergoing dialysis treatment. The protocol was approved by the Human Research Ethics Committee of the Pontificia Universidad Católica del Ecuador, with approval code CEI-88-2020. Results: the thematic analysis showed that doctors need to comprehensively ethically and clinically evaluate the patient before maintaining or terminating hemodialysis; The level of knowledge and ethical-clinical skills influence decision making. Furthermore, the application of Beauchamp and Childress' bioethical principles to decision making is vague, morbidly confusing, and therefore irrelevant to this type of decision. Conclusions: doctors perceive the need to comprehensively evaluate the patient, taking into account not only the physical but also the psychological, social and economic condition of the patient. They consider it unnecessary to maintain hemodialysis treatment in a patient with a deteriorated quality of life, with reduced autonomy and whose prolonged treatment could cause more pain than benefit.

Keywords

• futilidad médica
• autonomía profesional
• autonomía personal
• toma de decisiones clínicas
• ética basada en principios