A septic patient requires haemodialysis, but the patient refuses. What do you do?

• A. Respect the decision and do not discuss it further
• B. Open and private discussion with the patient about concerns, indications for haemodialysis and what can be done to alleviate concerns, including risks and benefits, and involve family or senior input if needed
• C. Force dialysis to proceed
• D. Transfer the patient to another facility without discussion

Answer: (B)

This question centers on respecting patient autonomy and ensuring informed decision-making when a potentially life-saving treatment is on the table. Even in a septic patient, decisions about dialysis should be based on assessing whether the patient has decision-making capacity and on providing complete, understandable information.

You open a private discussion with the patient to explore their concerns and to clearly explain why dialysis is being considered, what indications exist, and what the risks and benefits are. You outline what dialysis can and cannot achieve in this situation, and discuss possible alternatives or supportive options if the patient declines. Importantly, you address misunderstandings, fears, or cultural or personal values that influence the decision, and you offer involvement of family or a senior clinician if needed to support understanding while still centering the patient’s preferences.

This approach is best because it upholds autonomy, promotes truly informed consent, and avoids coercion. Forcing treatment or transferring care without discussion would undermine the patient’s rights and could lead to decisions that don’t align with their values. If capacity were absent, you would involve appropriate decision-makers or the medical team to determine the best course in the patient’s best interests.