Spiritual distress in dialysis: A case report

The dialysis cohort in Australia, as in other parts of the world, is becoming increasingly elderly and frail. The incidence of dialysis withdrawal prior to death is also increasing, often driven by clinical deterioration and/or psychosocial factors. Despite expertise in the biomedical aspects of dialysis, nephrologists may feel less equipped to explore the existential and spiritual aspects influencing a patient’s decision-making. We present the case of an elderly woman for whom dialysis became increasingly challenging and burdensome as her global condition deteriorated. Despite multiple discussions being held regarding elective cessation of dialysis the treating team was unable to progress to a decision to withdraw. Shortly before her death the patient revealed, for the first time, the key influences of her religious beliefs to the community-based palliative care team. She described a strong Catholic faith and although unafraid of death itself, she was fearful that her decision to stop dialysis would be akin to suicide and therefore a mortal sin. Her condition deteriorated before these concerns could be further explored and she died in the intensive care setting with a high level of intervention. All people have a spiritual dimension that may influence their attitudes towards death and medical decision-making. If not elucidated, it can create barriers to appropriate care, as in this patient. There are many approaches to exploring these domains including validated tools to support clinicians who have not received dedicated training.