| Ethical problems | n = 208 | |
| Principles (74%) | Patient participation problematical | Doubt about decision-making capacity | 33 | The patient is not aware of his illness. He fails to see why he needs dialysis. He often stays away from the dialysis as he feels he doesn’t need it. |
| Ambiguous responsibility for decision | 29 |
| Lack of adequate information | 19 |
| Doubt about in whose interest to continue treatment | 8 |
| Exposure to suffering | Burdensome situation | 21 | Problems with long-term pain and a lot of problems with daily vomiting, he wants to eat food but it just doesn’t work out. I think they have dragged out the whole thing too long. |
| Debasing treatment | 16 |
| Doubt whether it is right to continue treatment | 19 |
| Allocation of resources | Consideration of other patients | 9 | Is it fair to the other patients to give him a kidney when he is so non-compliant? What resources are reasonable to expend, which are then taken away from other patients? |
| Persons (12%) | Personal responsibility | Insufficiency as carer | 14 | The woman screamed and was in pain. Nothing helped. I felt powerless. Other patients heard her screams. It was frustrating not being able to help her. |
| Uncertainty about mental posture towards the patient | 11 |
| Perspectives (14%) | Difficult to understand the patient | Difficult to know patient’s thoughts | 17 | Do we know if the patient is hunger striking just to stay in the country or wants to quit dialysis because he wants to die or is he doing it for the family or because he is psychotic and can’t keep it together? |
| Double messages from patient regarding death | 12 |
| How to solve | n = 209 | |
| Principles (30%) | Promote patient participation | Inform patient/family about treatment | 28 | Explain to the family more exactly what dialysis involves and how difficult it is for the patient. |
| Alleviate suffering | Help the patient decide | 26 |
| Decide to withdraw treatment | 8 | The physicians should have tried to decide how and if the patient was to be treated at an earlier stage. |
| Persons (14%) | Be brave | Question the doctors | 20 | That we look to the patient’s best interest and not to the prestige of the medical profession or be afraid of going against someone else’s decision. |
| Dare to speak out | 10 |
| Perspectives (56%) | Enhance team collaboration | Request for interprofessional dialogue | 43 | Discuss together, doctors and nurses. Easier to understand why the treatment continues despite the patient’s condition. |
| Reach a consensus for care | 24 |
| Enhance patient/familycontact | Give psychological support | 41 | Help the patient take an active part in his care. In some way help the patient cope with the situation and take care of himself and his health. |
| Try to understand the patient | 9 |