DOLPHY AND THE NEED FOR DIALYSIS

English: Dolphy, Filipino actor

English: Dolphy, Filipino actor (Photo credit: Wikipedia)

“Most nephrologists would agree that patients who are likely to have an unacceptable quality of life should not be subjected to the discomfort of dialysis. Sparing such patients the inconvenience and discomfort of hospital attendances, surgical access procedures, and dialysis treatments is a major benefit.”

– Indranil Dasgupta and Hugh C. Rayner

  Consultant Nephrologist, Renal Unit, Birmingham Heartlands Hospital, United Kingdom

A living legend needs our prayers.  Comedy King Dolphy, whose comedic talent has brought laughter and cheer to multiple generations of radio, TV, and movie followers, was recently admitted to the Intensive Care Unit and is said to be suffering from Toxic Metabolic Encephalopathy.  The illness requires regular dialysis treatment, because his kidneys can no longer do the job of removing toxic wastes from the body.  This has affected his brain function, thus the medical term “encephalopathy”, which generally refers to an illness that affects brain.  As a hospice and palliative care practitioner, I decided to look into the benefits and risks of dialysis treatment on our 83-year-old comedy king.

According to studies,  patients on dialysis are subject to much more intensive medical care in the last month of life than are patients dying of cancer or heart failure.  Data reveal that 30% of dialysis patients receive intensive procedures, a rate that is three times higher than that of cancer patients. Also, only 20% of kidney-failure patients are referred to hospice, compared with 40% of the patients dying of heart failure and 55% of cancer patients.  Among patients 75 and older, the five-year survival rate for patients on dialysis is 15%.

This brings us to some  important questions.  Is it sometimes better to provide supportive and palliative care without dialysis to an elderly patient with renal failure?  Can dialysis be safely delayed when the benefits remain uncertain at best?  What does conservative management entail, and how should it be given?

According to experts, a patient over 75 who has heart disease, diabetes, liver failure, severe chronic obstructive pulmonary disease (COPD), or other significant chronic illnesses will have little to gain from dialysis.  A more conservative approach with the consent of the patients and relatives may be better.  What could be more cost-effective is to treat anemia and ensure acid-base and fluid stability.  Health care workers who are well-versed in hospice and palliative care should also be on hand.

However, it must be stressed that data can only serve as a guide.  The best medical decisions rest on a collaborated effort between doctors, nurses, caregivers, social workers, the patient’s family, and the patient himself.  Our prayers for Dolphy would also be invaluable, not just to prolong his life indefinitely, but to pray that he is at peace with himself and with his Creator.

MEDICAL CARE PLANNING AT THE END OF LIFE

CPR training

Image via Wikipedia

Inspite of all the advances in technology, there are still instances when curing an illness is no longer an option. At this stage, patients must be given the power to make treatment decisions. A patient may opt for aggressive measures to prolong life or stop treatment altogether, which could mean dying sooner but more comfortably. To carry out these options, it is essential to talk to your physician about having Advance Directives.

The components of an Advance Directive are as follows:
1. A LISTING OF POSSIBLE THERAPEUTIC OPTIONS
These would include being amenable to cardiopulmonary resuscitation, mechanical respiration, tube feeding or other invasive forms of nutrition, blood transfusion, surgical procedures, kidney dialysis, and antibiotic treament.

2. PRIMARY DECISION MAKERS
In case the patient can no longer decide on his or her treatment, a proxy decision maker must be designated. In the absence of this directive, in order of significance, the following may be designated: 1. the spouse 2. children above 18 years old 3. parents, and 4. siblings.

3. ORGAN DONATION DIRECTIVE
When preferred, a person may choose to have any organ donated to others upon his or her demise. The organ, or the whole body, can be donated for this purpose.

The directive must be signed by the patient and followed up periodically for any changes. Two witnesses may also appear as signatories on the Advance Directive form.

Lastly, it must be emphasized that the advance directive is not a legal document but a tool to facilitate treatment decisions.
Caring at the end of life focuses on making patients comfortable and preserving the dignity of human life. Patients still receive appropriate medications to control pain and other symptoms. Some patients choose to die at home instead of in a hospital. This is acceptable because the hospital may not be the place preferred by the patient. In either case, Advance Directives may be applied to help patients and their families deal with issues surrounding death.