Ethical Aspects in Choosing Renal Replacement Therapy: an Integrative Review

Abstract

The aim of this study is to address ethical issues related to renal replacement therapies. Ideally, therapeutic decisions should be made by the user, with the support of a multidisciplinary team, with nursing as a point of integration in this context. By respecting the principle of autonomy, the user, once informed, would be able to
choose the best treatment to meet his/her needs. However, the paternalism present in the decisions of the health team, which believes that they know what is best for the patient, combined with the underfunding of renal replacement therapies, leads to poor communication and lack of clarification of therapeutic options to the patient, whose fate is determined by health professionals. This is an integrative review. The search in the databases was carried out in the Virtual Health Library (VHL) and Pubmed (via MEDLINE). Dialysis treatment is not available to all patients who need it, and is a serious global public health problem, affecting both chronic kidney disease patients and those with acute kidney injury (AKI), especially in third world and developing countries. Due to the high prevalence of CKD, high costs and inequitable access to RRT, ethical issues have always been an intrinsic part of the history of nephrology and its development. In 2010, approximately 2.3
to 7.1 million deaths of people with end-stage renal disease without access to dialysis were recorded. One attempt to overcome these obstacles is shared decision-making, through clear communication that clarifies and informs the individual and family of the available therapeutic options, their risks, benefits and availability, so that care is centered on the patient and family and they are able to choose and consent to the chosen RRT.