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Master Thesis

Décision d’initiation de la dialyse chez les patients insuffisants rénaux chroniques stade terminal, en incapacité de donner leur consentement

Abstract : In 2016, approximately 50,000 patients in France were living on dialysis. Studies show that dialysis patients are the most difficult group to treat, but also in all aspects of their lives. The complexity of dialysis and its consequences require that all their needs be taken into account. The decision to initiate dialysis is therefore not a decision that is taken lightly. The decision to initiate long-term dialysis in patients with chronic inadequacy is a very common situation. The situations of patients who cannot give their full consent, which are also frequent, are discussed at meetings at the end of which a decision will be taken. The parameters that are taken into account and the stakes of the decision to initiate dialysis are multifactorial. They are the responsibility of both the patient and the care team. All these aspects, both objective and subjective, which influence the final decision, which is the responsibility of the referring nephrologist, are discussed in a multidisciplinary and multi-professional meeting. There are few tools for evaluating decision-making parameters. Our objective was to identify and assess the nature of the decision-making determinants in this type of situation and to highlight possible ethical tensions in this context. Our study shows that the nature and choice of decision-making determinants represent a combination of the principles of Evidence Based Medicine applied individually, with the patient at the centre of the decision. The shared decision resulting from multidisciplinary consultation meetings makes it possible to avoid the arbitrary nature of the subjective parameters and the personal and professional representations of each individual.
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Master Thesis
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  • HAL Id : dumas-02399892, version 1

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Corina Delimann. Décision d’initiation de la dialyse chez les patients insuffisants rénaux chroniques stade terminal, en incapacité de donner leur consentement. Ethique. 2019. ⟨dumas-02399892⟩

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