From what I’ve heard from doctors and family members of patients who chose to stop dialysis and died, dying of kidney failure is not painful, especially if the patient continues to limit his/her fluids. Leafsunbear is correct that once you choose not to do dialysis, there is no renal diet to follow and I’ve heard of patients who chose to stop and ate all their favorite forbidden foods.
I’ve worked with a number of patients over years who decided to stop dialysis. Usually this happened when their health had failed and they were very limited in their ability to enjoy life or when they developed a new terminal diagnosis. I have to say that I can’t remember a single home dialysis patient who made this choice whereas I knew several in-center dialysis patients who did. I do not remember anyone who made this decision lightly. I always got the feeling that they had thought about it for a long time. We always offered a referral to hospice. The hospice nurses kept the nephrologist informed of how the patient was doing and the nephrologist could make sure that the patient had any medications for pain or anxiety that they needed when they needed them. The families really seemed to appreciate the medical and emotional support they received from the hospice team.
In my opinion and the opinion of most of the organized religions, it is not a sin to stop dialysis. The issue of whether stopping dialysis is suicide has been discussed in great detail. The consensus of major organized religions is that stopping dialysis or choosing not to start dialysis is NOT suicide. It is allowing natural death to occur by not choosing to start or choosing not to continue mechanical support.
The National Kidney Foundation has two brochures on this topic and the issue of suicide is addressed:
– Dialysis: Choosing to Stop
http://www.kidney.org/atoz/atozItem.cfm?id=40
– Dialysis: Choosing Not to Start
http://www.kidney.org/atoz/atozItem.cfm?id=28
When I talked with people considering this option, I wanted to be sure that we had done all we could to give them hope and meaning. I didn’t want someone to make this final of a decision if they had treatable depression. I also wanted to be sure we had done all that we could to make dialysis fit best with their lifestyle and be sure we had addressed any issues related to symptoms and dialysis comfort. I wanted to hear that they had discussed their decision wiith their doctor and with their loved ones and that all accepted their decision. Some family members talked with me before or after the patient’s death telling me about how they had come to accept loved one’s decision and how their loved one died peacefully. Finally, I wanted to be sure that their spiritual needs were met and that they had either talked with their minister or other spiritual advisor or felt no need to do so. I often think of the patients with whom I had these discussions and what I learned from them about living and dying with dignity.