Clin J Am Soc Nephrol. 2013 Nov 14. [Epub ahead of print]
The Demented Patient Who Declines to Be Dialyzed and the Unhappy Armed Police Officer Son: What Should Be Done?
Source
Division of Nephrology, University of Alabama, Birmingham, Alabama;, †ESRD Network of Texas, Inc., Dallas, Texas;, ‡Patient Care Services, Mid-Atlantic Renal Coalition, Richmond, Virginia;, §Dialysis Clinic, Inc., Nashville, Tennessee, ‖Section of Nephrology and Center for Health Ethics and Law, West Virginia University, Morgantown, West Virginia.
Abstract
Dialysis personnel are responsible for ensuring that patients' rights and physical safety are protected in dialysis centers. Treatment of patients with cognitive impairment, including patients with dementia, presents special challenges. These patients may attempt to pull out their dialysis needles during treatment, potentially endangering themselves, dialysis center personnel, and other patients. Such patients may also compromise the care of other patients in the center by upsetting them and requiring a disproportionate amount of staff attention during treatment. Dialysis centers have learned to require families of such patients to provide a sitter to ensure that the patient remains safe during the dialysis treatment; however, some patients may exhibit unsafe behaviors despite a sitter, and not all families are willing to provide a sitter. In some instances, family members respond to the stress of a loved one who is unsafe on dialysis by being verbally or physically abusive to dialysis staff. This article presents a case in which the family member was a police officer who was not only verbally and physically intimidating to the staff but also insisted on bringing his police service weapon into the dialysis center. It describes the psychosocial, ethical, and legal responses to a family member who is disrupting what should be a calm environment in the dialysis center and recommends that dialysis centers proactively develop policies concerning safety for patients, family members, and other visitors that make no exceptions. The case also highlights the importance of adopting a no weapons policy and posting and enforcing a no weapons sign.
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