The palliative approach to patients with ESKD includes managing all aspects of the physical, emotional and spiritual dimensions of the illness and care of the family. That breadth perfectly accords with modern medical beliefs in the interrelatedness

of body, mind and spirit in the experience of illness for all human beings Health R788 price professionals dealing with patients with ESKD need to acquire skills in these areas. Given that no one health professional can provide all treatment, support and assistance needed a critical ethos of the palliative approach is the multidisciplinary team (MDT). Continuing collaboration between renal medicine and palliative medicine is essential. Given that there is currently, and will for the foreseeable future be, a shortage of Palliative Care health professionals the onus should be on all disciplines, including Nephrology, to acquire and nurture basic skills

in the palliative approach to patients, including skills in discussions around the possible withholding of and withdrawal from dialysis, symptom management, psychosocial support and the appropriate care of the dying patient. The cultural and religious beliefs of patients may inform or determine their view on medical decision-making including in relation to the withholding or withdrawing of dialysis and the care of the dying. It is therefore important that clinicians explore these beliefs with patients PD0325901 ic50 and their families. In modern societies patients may or may not have a religious faith but all patients have spirituality. Most religions believe that

withdrawal from or withholding treatment, including dialysis, Atazanavir is acceptable when this is in the patient’s best interests. A core competency of Nephrology should be the capacity to diagnose dying. Failure to do this or procrastination in this recognition may result in neither the clinicians nor the family being prepared for the possibility of death. That unpreparedness may have a significant impact on the bereavement of the family. Withdrawal of dialysis is ethically and legally valid; once the dying phase has been recognized and acknowledged it is important that invasive tests are ceased so as not to add to or prolong suffering. An increasing issue is the need to deprogramme AICD; this specific issue should be discussed with the patient and his/her cardiologist. It is important at this time to be specific that deprogramming AICD does not constitute euthanasia or physician-assisted suicide, that deprogramming AICD will not cause death and that the process of deprogramming is not painful or make the process of death more painful. The time to death after withdrawal varies considerably, averaging 10 days for most patients but 3 weeks or even longer for those with residual renal function.