Palliative care* is a type of specialized health care for patients and families facing life-limiting illness, and advanced stage chronic kidney disease is one such illness.

Palliative care helps patients achieve the best possible quality of life right up until the end of life.

Quality palliative care encompasses the following:

• focuses on the concerns, hopes, and fears of patients and their families (what matters most);
  
• pays close attention to physical symptoms such as pain, nausea, loss of appetite, confusion;
  
• considers the emotional and spiritual concerns of patients and families;
  
• ensures that care is respectful and supportive of patient dignity and autonomy; 
  
• respects the social and cultural needs of families;
  
• uses a multi-disciplinary approach that may include social workers, spiritual leaders, pharmacists, dieticians, nurses and physicians.
  

Palliative care does not necessarily end when someone has died.  Family members may need support as they grieve the loss of a loved one.  Bereavement programs are often part of comprehensive palliative care.

*Adopted from: Canadian Virtual Hospice

• Talking with your clinician about the future
  
• Talking about your illness with loved ones and caregivers
  

Conservative care for a renal patient means choosing not to do dialysis and not to have a kidney transplant. Talk to your renal care provider before you decide if conservative care is the right option for you.

BCR's Modality Choices Presentation can provide additional information on conservative care.

BC Renal Stopping Dialysis Booklets: 

• Thinking of Stopping Dialysis
  
• FAQs of Stopping Dialysis
  

‎For any patient on dialysis, there may come a time when he or she may feel that dialysis no longer improves their quality of life or meets their personal and health care goals. If this happens, the patient has the right to discontinue dialysis treatments and opt for conservative care.

If a patient feels that dialysis is no longer a suitable treatment option for them and would like to stop this treatment, first, it is extremely important to discuss their decision with their loved ones and their care team (kidney doctor, nurse, dietician, social worker, etc.).

The care team will want to understand precisely why the patient would like to stop dialysis. The reasons to discontinue treatment may include worsening health, depression, changing personal goals, declining quality of life on dialysis, and others. In some cases, the patient's doctor may be able to make adjustments to the patient's treatment routine that may improve their situation and provide more information or context to assist in their decision to stop.

If the patient's decision is final, their care team will be able to explain in detail what happens to their body when they stop dialysis as well as what kind of care the patient will receive once they stop. The patient's care team will be available to them regardless of their decision to discontinue dialysis.

The decision to stop dialysis can be reversed at any time. If the patient decides to restart dialysis after stopping, he or she should talk to their care team immediately.

Stopping dialysis is not considered suicide. It is a well-recognized and accepted treatment choice that results in a natural death due to kidney failure.

In general, when a patient with kidney failure decides to stop dialysis, he or she may expect to live between several days and several weeks, depending on their health condition, while their body naturally declines and eventually dies.

The experience and symptoms of patients who choose to stop dialysis can vary significantly. Most commonly, the patient will feel tired and drowsy, and may eventually slip into a state of unconsciousness. 

Patients who choose to stop dialysis should be aware that any negative symptoms such as pain, nausea or difficulty breathing can be reasonably controlled with medication that a doctor (family physician, kidney specialist or palliative care specialist) will be able to prescribe depending on the patient's individual situation.

‎

You can find more information on stopping dialysis in this Kidney Foundation of Canada pamphlet. For more information on conservative care see the following Kidney Foundation of Canada pamphlet or refer to BC Renal's  Treatments for Kidney Care presentation. 

‎In Canada, medical assistance in dying (MAiD) is legal under Bill C-14 passed by the Canadian Government on June 17, 2016.

Under this legislation, doctors in Canada are legally able to provide assistance in dying to competent adults seeking this service who have a "grievous and irremediable medical condition that causes enduring, intolerable suffering". In other words, this means all of the following:

• a person is suffering from a serious and incurable illness, disease or disability;
  
• the person’s decline in capability is advanced and irreversible;
  
• this condition is causing the person intolerable physical or psychological suffering, which cannot be relieved in an acceptable manner; and
  
• the person’s natural death can be reasonably foreseen.
  

Talk to your doctor if you, or a loved one, are considering this option and want to know if MAiD or other services may be suitable for your personal situation and needs.

Medical assistance in dying is not the same as stopping dialysis. When a patient chooses to seek and receive MAiD, he or she should expect to die on the day of their choice from a special combination of medications administered to them. To learn more about stopping dialysis, please see the respective section on this Palliative Care page.

In British Columbia, the Ministry of Health and all health authorities have set up web pages that provide comprehensive information on MAiD to the public. Each health authority also has a MAiD Care Coordination Service, Centre or Office that can offer additional advice:

• BC Ministry of Health 
  
• Fraser Health
  
• Interior Health
  
• Island Health
  
• Northern Health
  
• Provincial Health Services Authority
  
• Vancouver Coastal Health
  

View and download here a basic PHSA information sheet with frequently asked questions about MAiD.

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