La décision d'arrêter la dialyse : quel est l'impact des lois sur la fin de vie ?

A dialysis treatment for a patient with an end-stage renal failure is a life sustaining treatment. With the development of techniques, and also with a possibility of treatment for patients with various associated comorbidities, dialysis can become an unreasonable obstinacy. Before the French law about the end of life, such decisions were made, but often in a non-explicit manner. The question about decision was difficult: was it a right, was it possible to withdraw a life sustaining treatment? And if it was, how was it to be done, and who would make the decision? The aim of this paper is to show how the law about end of life gave a framework for such decisions: withdrawing dialysis is a patient's right, a duty for care carriers when dialysis becomes unreasonable obstinacy. A collegial procedure is required when the patient is not aware, consulting the support person and the advanced directives (encouraging patients to write them). Finally assistance of palliative care professionals is a big help to make decision and to support the patient and his relatives. The present work shows that even if the patient is aware, this multidisciplinary process is systematically done. Indeed some questions remained, first the temporality of each person, patient, relatives, medical/nurse staff, how would it be possible to reconcile various views? Another question is the place of the end of life, at home, retirement home, a nephrology unit: how can this support be organised upstream? Indeed, this end of life is not always predictable…