Dying with Dignity: A Hemodialysis Medical Assistance in Dying (MAID) Case

The goal of patient care in nephrology is to achieve good quality of life for patients with chronic life limiting illness. End-stage renal disease (ESRD) is associated with limited life expectancy, high morbidity and burden of symptoms. Dialysis is often burdensome and increasingly patients, families and healthcare teams express doubts about the quality of life of individuals with multiple other health problems (Brown, Chamber & Eggeling, 2008). Among patients on dialysis, survival rates and complexity of comorbidities are increasing; in addition, withdrawal from dialysis is becoming a more common cause of death in these patients. The prognosis and outcome of this patient population can be difficult to predict. This unknown aspect in health care can be emotionally taxing to the patient and his/her family and presents unique medical and ethical challenges (Rak et al., 2017). End of life care is multifaceted and may include palliative care, psychological support, spiritual care and MAID. MAID is available for patients meeting specific eligibility requirements to decrease suffering from grievous and irremediable medical conditions of the right to life, liberty and security of the person. This case of a vintage hemodialysis patient will exhibit patients' perspectives of suffering and inability to cope, demonstrate the UHN MAID process and role of an interdisciplinary team and provide an ethical framework for decision making during end-of-life care.