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The Impossible Choice

Carl M. Kjellstrand, MD
JAMA. 1987;257(2):233. doi:10.1001/jama.1987.03390020099036.
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"No, Doc," he said, "I can't stand it anymore. No one should have pain like this and when you give me the medicines I throw up and I see things that aren't there and I'm scared to death."

He had been using the artificial kidney for five years. A proud and private man, he seemed to have no friends and did not get along well with the staff. Then he developed circulatory insufficiency, small-vessel disease, in both legs. There was nothing for the surgeons to do. When we tried analgesics we caused his nausea and changed unendurable pain to unendurable horrors of hallucinations that clouded his mind. When we treated the nausea it made the other things worse. All we could do was to amputate both legs. He refused to have that done and decided to stop dialysis and die.

"Listen, Doc," he said. "I'm 68 years old, I live


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