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Sometimes your renal doctor          decision not to have dialysis or   No matter how you have come
        may think that the burden of         to accept your doctor’s            about to making a decision to
        dialysis, in addition to your        recommendations for                choose conservative care, your
        kidney failure and other serious     conservative care. They may        choice will be documented and
        medical conditions, outweigh the     believe that they should defend    supported.
        benefits of starting dialysis        your right to access dialysis, no
        treatment. If this is the case, he   matter what its effect on your     Having reached a decision, your
        or she may recommend                 quality of life and overall well   emotional reaction and those of
        conservative care as the best        being.                             your family can be very intense.
        treatment choice for you.                                               This is a time when you may
                                             Family meetings with medical       feel fearful, depressed, angry
        At other times medical staff and     and nursing staff are useful in    and confused, even hopeless.
        your family may recommend            helping you and your family to     You and your family may have
        dialysis treatment, when you         understand all the factors         concerns that need to be
        would prefer a more conservative     involved and to weigh up the       addressed and resolved. Your
        approach. Reaching a decision on     pros and cons of dialysis          healthcare staff can help clarify
        what treatment choice suits you      treatment against conservative     any questions you may have
        can be very difficult.               care. If there is any              and can talk with you about
                                             disagreement, your comfort,        your thoughts and feelings.
        Family members may have              dignity, wishes and values         Some hospitals may have
        unrealistic expectations of what     should be respected and            access to trained professionals
        dialysis can achieve for you and     supported by your family and       who can help you through this
        may be reluctant to accept your      healthcare team.                   difficult time.


                                              Compare your options

                        Start or continue dialysis                   Refuse or stop dialysis

         What is        You start or continue to get dialysis treatments  Your body will start to shut down, and you will
         usually        several times a week at a dialysis unit close to  experience normal changes from the dying
         involved?      you.                                         process.
                                                                     You may need the support of a palliative care
                                                                     team as your kidney failure will, in due course,
                                                                     lead to your death.
         What are       Dialysis keeps you alive longer so you don't  You no longer have side effects or problems from
         the            have to deal with dying yet.                 dialysis.
         benefits?      When you start dialysis you may feel better  You no longer need to limit what you eat and
                        than you did before you started treatment.   drink.

                        You may be able to return to normal activities.  The time you have left is your own to spend with
                                                                     friends and family, not on dialysis treatments.
                        Treatment may allow you to achieve plans that
                        you have set for yourself.                   Your quality of life may be better.
         What are       Dialysis won't cure you.                     You will probably die within a few weeks, if you
         the risks ?    Dialysis may involve frequent travel to and from  have stopped dialysis treatment or within months
                        where you have treatments.                   if you have declined dialysis treatment.
                                                                     As you near death, you'll face end-of-life issues
                        Dialysis takes a lot of time and can affect your
                        quality of life.                             that may be hard to deal with.

                        Dialysis has risks, including infection, low blood
                        pressure, fever, abnormal heart rhythm, and
                        muscle cramps.



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