Nephrologists' reported attitudes about factors influencing recommendations to initiate or withdraw dialysis

Jean L. Holley, Charles J. Foulks, Alvin H. Moss

Research output: Contribution to journalArticlepeer-review


A nationwide survey of nephrologists was performed to learn which patient factors and characteristics of nephrology fellowship training they reported as influencing their decisions to start or stop dialysis. One hundred seventy-four of 482 responses were received. Most respondents were men in private practice living in large communities (41% in communities over 1,000,000 population). Most had completed a 2-yr fellowship (88%) at a medical school hospital (75%). Few (9%) received formal instruction in medical ethics during fellowship training, and only one quarter had informally discussed life-sustaining treatments during training. Neurological status was the most, and age the least, important patient factor reported to influence decisions to start or stop dialysis. No respondent demographic factors correlated with ranking of patient factors in decisions to initiate or forego dialysis. Family wishes and preexisting medical conditions were significantly more important considerations in initiating than in stopping dialysis. Insights about the factors practicing nephrologists reportedly weigh most heavily in making the difficult decisions to withhold or withdraw dialysis are provided by this study. Additional study of the actual practices of nephrologists in decisions to initiate or withdraw dialysis and the factors influencing those decisions are needed. Formal instruction in these and other ethical problems confronting nephrologists should perhaps be included in fellowship programs.

Original languageEnglish (US)
Pages (from-to)1284-1288
Number of pages5
JournalJournal of the American Society of Nephrology
Issue number12
StatePublished - Jun 1991
Externally publishedYes


  • Dialysis
  • Life-sustaining treatment
  • Medical ethics

ASJC Scopus subject areas

  • General Medicine


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