Ethical Decision-Making in Pediatric Dialysis

Dialysis is a lifesaving intervention for children with end-stage kidney disease. In some cases, it may be appropriate to forgo dialysis treatment. This chapter will review the history of provision of dialysis, the best interest standard and harm principle in pediatric medical decision-making, the technological imperative, and the ethical equivalence of withholding and withdrawing life-sustaining treatments like dialysis. Next, we will review considerations of and a process for forgoing pediatric dialysis including addressing disagreements, futility, available resources, and time-limited trials. Finally, we will consider decision-making for special populations including fetuses and pregnant women, neonates, the developmentally disabled, those with multiple comorbid conditions, those who cannot be transplant candidates, undocumented immigrants or refugees, and adolescents nearing adulthood.