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Nephrology (Carlton). 2013 Apr 16. doi: 10.1111/nep.12086. [Epub ahead of print]

Legal issues concerning withholding and withdrawal of dialysis.

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Center for Health Governance, Law & Ethics, Sydney Law School, University of Sydney.
Depts of Renal Medicine and Palliative Medicine, St George Hospital, Kogarah, NSW.


A doctor incurs no civil or criminal liability if, on the basis of a refusal to commence or continue dialysis, the doctor does not give that treatment. To go ahead and give treatment to a patient who has refused consent, constitutes a battery. If the actions of a Nephrologist are reasonable in withholding dialysis or withdrawing from dialysis then it is highly unlikely that a successful action in negligence would occur. The law does not obligate a Nephrologist to provide treatment that they believe is of no benefit to the patient or that any benefit is outweighed by the burdens of the treatment, but best practice requires that the Nephrologist communicate with the substitute decision-makers regarding the patient's best interests. The withholding of or withdrawing from dialysis is not euthanasia. Equally it does not constitute Physician Assisted Suicide. If a patient is competent the decision whether or not to consent to dialysis is that of the person. The family cannot insist on dialysis. If the patient is incompetent and the surrogate decision makers or families have reached an impasse with the clinician then some simple preliminary steps may be taken, including seeking a second opinion but it may require seeking clarification with the Supreme Court of the jurisdiction.

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