Diverse pattern of ethical concerns related to kidney replacement therapy in clinical ethics consultations in advanced treatment hospital

Background Clinical ethics consultation is a system primarily implemented in healthcare facilities to address “clinical ethical issues, value conflicts, and dilemmas faced by staff, providing advice and recommendations after timely deliberation by a multidisciplinary team.” When uncertainty arises regarding the best course of treatment for a patient, the system helps organize issues, facilitates discussions among multidisciplinary teams, and fosters consensus building. Methods We analyzed cases from the past 8 years at our hospital that required ethics consultations related to kidney replacement therapy. Results Various ethical issues were identified for patients with kidney failure requiring kidney replacement therapy, including not only the nature of kidney replacement therapy as end-of-life care but also fairness in the distribution of healthcare costs in advanced medical care, the futility of life-sustaining treatment, and the extent to which patient self-determination should be protected. Conclusions The ethical challenges inherent in kidney replacement therapy were addressed through a process in which the healthcare team, including the patient and their family, engaged in discussions to reach a conclusion.