Table 1:

Avoiding Clinical and Ethical Pitfalls as Renal Failure Occurs

Healthcare Teams Should:
Upon diagnosis, cultivate an interdisciplinary relationship which is maintained throughout the illness trajectory
Initiate renal consultations far in advance of potential need for dialysis to provide anticipatory guidance to patients, surrogate, family, and other healthcare providers
With patient’s consent, include surrogates, agents, family members, or close confidants in renal consultations and discussions of goals of care and end-of-life care
Encourage patients to inform surrogate decision maker or family members about care preferences
Consistently document the patient’s expressed wishes, including the reasons for his/her choices. Direct quotes are helpful
Appreciate that their first ethical obligation is to respect patient autonomy and to honor the patient’s wishes