Introduction/background:

This is an intricate case presentation. Dialysis is postponing an inevitable death but is causing extreme suffering for no gain. The complexity is further compounded by the fluctuating incoherence of the patient and the lack of clear guidance from her support network.

Case description:

The case study was a 42-year-old female on hemodialysis. She has presented over time with extremely painful gangrenous toes and her physical condition has deteriorated due to frequent hospital admissions. Her extensive medical history includes Bardet-Biedl Syndrome, obesity, cardiomyopathy, a failed kidney transplant and other conditions. As her condition deteriorated, the management of her condition became more challenging because of her young age, complex medical history, and psychosocial problems.

Discussion:

Worsening pain from gangrenous ulcers resulted in five hospital admissions. Multiple vascular procedures and high dosage of opioids and anxiolytics had minimal benefit. She gradually lost her capacity to make decisions and thus relied on her support network which was fragmented and conflicted. Dialysis, in this case extended the patient’s life. The patient and her support system did not want to cease the therapy although it was contributing to her suffering and distress. However, because of integrated guidance from health care professionals, a consensus was reached to discontinue dialysis and the positive outcome of a peaceful death was achieved.

Conclusion: 

Approach to end-of-life care is not simple, particularly when there are conflicting interests and views involved. However as long as the interests of the patient are always paramount, all hurdles can be negotiated.