OBJECTIVE: The vast majority of physicians frequently faces ethical dilemmas and feels overwhelmed as a result. Those at Boston Medical Center are no exception. Various studies show more adept handling of ethical issues can improve the quality of care and patient safety by reducing moral distress of physicians and fostering better patient-physician relationship. The method of Preventive Ethics, which actively identifies recurrent themes and underlying systematic issues among ethics consultations, is more effective than the traditional, case-by-case approach in reducing the number of ethical conflicts. The purpose of this study is to identify common themes prompting ethics consultations and any hotspots among recurrent ethical dilemmas at Boston Medical Center by using the Armstrong Clinical Ethics Coding System. METHODS: A total of 32 ethics consultations handled by the BMC Ethics Committee between October 2010 and April 2013 were reviewed. Each consultation was coded using the Armstrong Clinical Ethics Coding System. The data was analyzed to identify the types of ethical dilemma that are most prevalent at BMC. The consultations involving the most frequently occurring issues were evaluated further to expose common themes among these cases and potential underlying systematic failures. RESULT: "Clinical Candidacy or Risk / Benefit Analysis" (6.25%), "Concern About Decision Maker Choices" (14.6%) and "Futility / Inappropriate or Nonbeneficial Treatment" (13.5%) were the most prevalent types of ethical issues at BMC. Not only are these three frequently occurring, they also have a very high tendency to occur simultaneously. Further analysis of consultations involving these three issues revealed that at BMC, there are frequent instances of conflict, in which family members serving as healthcare proxies disagreed with physicians in deciding the best interest of patients with severe ailments, ultimately precipitating ethics consultations. DISCUSSION: Comparison with similar retrospective studies previously carried out at other institutions suggests that consultation involving the issue of futility may be more frequently occurring at BMC, which might be coming from unique systematic problems. Several interventions such as improved policies or educational training in physician-family communication should be considered. CONCLUSION: According to the principles of Preventive Ethics, the issue of physician-healthcare proxy conflict regarding patient futility should be issue to be addressed at BMC. The Armstrong Clinical Ethics Coding System can serve as a much needed standard documentation format for ethics consultations, which would open up the possibility of more detailed future studies

Dissertação(mestrado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2012. / Submitted by eloisa silva (eloisa1_silva@yahoo.com.br) on 2013-01-11T12:44:51Z No. of bitstreams: 1 taniavasques.pdf: 1211854 bytes, checksum: 38f410e383455c8514629775645d6efd (MD5) / Approved for entry into archive by Bruna Vieira(bruninha_vieira@ibest.com.br) on 2013-06-12T17:27:34Z (GMT) No. of bitstreams: 1 taniavasques.pdf: 1211854 bytes, checksum: 38f410e383455c8514629775645d6efd (MD5) / Made available in DSpace on 2013-06-12T17:27:34Z (GMT). No. of bitstreams: 1 taniavasques.pdf: 1211854 bytes, checksum: 38f410e383455c8514629775645d6efd (MD5) Previous issue date: 2012 / Cuidados Paliativos (CP) tem o propósito de melhorar a qualidade de vida de pacientes que recebem um diagnóstico de doença incurável que ameace a continuidade da vida, proporcionando-lhes um processo de terminalidade digno e com alívio do sofrimento. Este estudo teve como objetivo conhecer a percepção dos trabalhadores de Enfermagem que atendem pacientes em situação de impossibilidade de cura e com risco de vida acerca dos Cuidados Paliativos e de sua implementação no cotidiano do trabalho em saúde. Trata-se de um estudo qualitativo, desenvolvido no primeiro e segundo semestre de 2011, por meio da técnica de entrevista semi estruturada, realizada com vinte e três trabalhadores de enfermagem. O estudo foi submetido ao Comitê de Ética em Pesquisa na Área da Saúde (CEPAS/FURG) sob parecer de número 43/2011. Para a análise dos dados, utilizou-se a Análise Textual Discursiva, construindo-se duas categorias: Percepção dos trabalhadores de enfermagem acerca dos cuidados paliativos e Percepção dos trabalhadores de enfermagem acerca da implementação dos cuidados paliativos. Os resultados mostram um aparente desconhecimento dos trabalhadores de enfermagem sobre Cuidados Paliativos, e manifestações de sofrimento ao cuidar dos pacientes fora da possibilidade de cura e com risco de vida. Evidenciou-se ainda a necessidade de capacitação acerca da temática, enfocando um diálogo franco e aberto com os pacientes e seus familiares, evitando-se o sofrimento do paciente com a obstinação terapêutica. Verificou-se, ainda, que o processo decisório acerca dos cuidados a serem prestados a esses pacientes requer compartilhamento entre os profissionais, a fim de que tal decisão não seja exclusiva de uma só categoria. Ações de aproximação com a filosofia dos Cuidados Paliativos foram identificados, tais como:parar para tocar o paciente, dar atenção as suas queixas, entre outros. Ao finalizar o estudo pode-se dizer que a educação permanente direcionada aos trabalhadores de enfermagem que cuidam de paciente fora da possibilidade de cura e com risco de vida em relação aos cuidados Paliativos pode proporcionar uma assistência paliativa eficaz, atentando para a qualidade de vida do paciente cuidado, bem como para a a qualidade de vida no trabalho da equipe de enfermagem. Ações de cuidado embasadas nos princípios paliativos contribuem para proporcionar um fim digno a esses pacientes. / Palliative Care (PC) aims to improve life quality of patients who receive a diagnosis of an incurable disease that threatens life continuity, giving them a dignified process of terminality with relief of suffering. This study aimed to learn the perception of nursing workers who serve patients in situations of healing impossibility and life-threatening, about Palliative Care and its implementation in health daily work. This is a qualitative study, developed in the first and second semesters of 2011, through the semi-structured interview technique, performed with twenty-three nursing workers. The study was submitted to the Ethics Committee in Research in Health Area (CEPAS / FURG) under opinion number 43/2011. For data analysis, we used the Discursive Textual Analysis, building up two categories: Perception of nursing workers about palliative care and perception of nursing workers about the implementation of palliative care. The results show an apparent lack of knowledge about Palliative Care by nursing workers, and expressions of sorrow when caring for patients with no possibility of cure and life-threatening. It was evident, moreover, the need for training on the theme, focusing on a frank and open dialogue with patients and their families, avoiding the patient's suffering with therapeutic obstinacy. It was also noticed that the decision-making process about the care to be provided to these patients requires sharing among the professionals, so that such a decision is not exclusive to only one category. Proceedings of approximation to the philosophy of Palliative Care were identified, such as: stopping to touch patients, listening to their complaints, among others. At the end of the study, it can be said that continuing education in relation to Palliative Care, directed at nursing workers who care for patients with no healing possibility and life-threatening, can provide an effective palliative care, paying attention to the cared patient's life quality, as well as to the life quality at work of nursing staff. Care actions based in the palliative principles contribute to provide a worthy end to these patients. / Cuidados Paliativos (CP) tiene como objetivo mejorar la calidad de vida de los pacientes que reciben un diagnóstico de enfermedad incurable que amenaza la continuidad de la vida, dándoles un proceso digno de la terminal y el alivio del sufrimiento. Este estudio tuvo como objetivo conocer la percepción de los trabajadores de enfermería que atienden a los pacientes ante la imposibilidad de la curación y la amenaza para la vida-sobre los cuidados paliativos y su aplicación en el trabajo diario en la salud. Se trata de un estudio cualitativo, desarrolló la primera y segunda mitad de 2011, mediante la técnica de entrevista semiestructurada, realizada con veintitrés personal de enfermería. El estudio fue sometido al Comité de Ética en Investigación en el Ámbito de la Salud (CEPAS / FURG) aparecen bajo el número 43/2011. Para el análisis de los datos, se utilizó el análisis del discurso textual, la creación de dos categorías: Percepción del personal de enfermería sobre los cuidados paliativos y la percepción del personal de enfermería sobre la aplicación de los cuidados paliativos. Los resultados muestran una aparente falta de personal de enfermería en cuidados paliativos, y las expresiones de dolor para atender a los pacientes fuera de la posibilidad de la curación y potencialmente mortales. Era evidente la necesidad de capacitación en el tema, centrándose en un diálogo franco y abierto con los pacientes y sus familias, evitando el sufrimiento de los pacientes con obstinación terapéutica. También estaba el proceso de toma de decisiones acerca de la atención que debe proporcionarse a estos pacientes requiere compartir entre los profesionales, por lo que tal decisión no es exclusivo de una categoría. Las acciones de acercamiento con la filosofía de los cuidados paliativos fueron identificados, tales como dejar de tocar al paciente, preste atención a sus quejas, entre otros. Al final del estudio, se puede afirmar que la educación continua dirigidos al personal de enfermería que atienden a pacientes de fuera de la posibilidad de la curación y la vida en peligro, en relación a los cuidados paliativos pueden proporcionar cuidados paliativos eficaces, prestando atención a la calidad de vida de los atención de los pacientes, así como a la calidad de la vida de trabajo del personal de enfermería. Las acciones basadas en los principios de los cuidados paliativos que contribuyan proporcionando un final digno a estos pacientes.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This research aimed to understand the social representations of physicians and nurses about excessive investment related to the terminal patient during the health care process in an Adult ICU. The specific aims of such project were to describe how physicians and nurses mean the end of life and the excessive investment regarding the terminal patient, to investigate how such professionals evaluate their academic learning process concerning health care during the dying process, and to identify reactions and feelings of physicians and nurses related to the death of the terminal patient. It consisted of a qualitative, exploratory/descriptive research, founded on Social Representations Theory. Data collection techniques consisted on focused interviews and participant observations. Analysis was based on content analysis. The ethical principles were respected, so that the participants rights were preserved, and an Informed Consent Document was signed as a condition to participate in the research. Among the results, it was possible to observe that physicians and nurses build their social representations about dysthanasia in the ICU under the influence of several factors, having as a starting point the absence of teaching and preparation to deal with death in the hospital context during undergraduate studies and medical residency, as well as the complexity of the daily contact with death and the dying process, together with feelings and defense mechanisms, spirituality and religiosity. Moreover, there are assertions that dysthanasia really happens, the firm pleads of the family of the terminal patient admitted in an ICU, the great complexity of decision making, that begins before admission of the patient in the ICU, decisions whether to invest on the patient or not, and the criteria used to decide when to stop investing, the role of the health professionals team on decision making, the enormous preoccupations concerning ethical and legal repercussions related to the decisions made as concerns the Code of Professional Ethics and the Brazilian Law, besides absences and euphemisms employed when registering the diagnosis, prognosis and care offered to the terminal patient, and last, the expectation of a dignified death as concerns the professional himself and the family, wishing to die at home, together with the family, having accepted the end of life. This study concludes that there are urgent needs of improvement regarding multiple aspects related to death: its approach during undergraduate studies and residency; adequate communication among professionals during decision making process and during the professional activities in the ICU, the ponderation between the wishes of the family and the real possibilities of survival of the patient. It is important to consider the situation of the patient and think that, concerning a hypothetical end of life, everything the professional dispenses to the patient in an ICU is solely what he would not desire as a dignified death, for himself or his family members. / Esta pesquisa objetivou compreender as representações sociais de médicos e enfermeiros acerca do investimento excessivo no paciente terminal durante o processo de cuidar em uma UTI Adulto. Os objetivos específicos visaram descrever como médicos e enfermeiros significam terminalidade de vida e o investimento excessivo no paciente terminal; investigar como estes profissionais avaliam a sua formação acadêmica face ao cuidado no processo de morrer; e identificar reações e sentimentos de médicos e enfermeiros frente à morte do paciente. Constou de uma pesquisa qualitativa, exploratório-descritiva, fundamentada na Teoria das Representações Sociais. As técnicas de coletas de dados foram a entrevista focalizada e a observação participante. O processo de análise foi embasado na análise de conteúdo. Os princípios éticos foram respeitados, de forma a proteger todos os direitos dos participantes, com formalização da participação por meio de Termo de Consentimento Livre e Esclarecido. Dentre os resultados, observou-se que os médicos e enfermeiros constroem as suas representações sociais sobre a distanásia em UTI sob influência de múltiplos fatores, partindo da ausência do ensino e preparação para lidar com a morte no cotidiano hospitalar durante a graduação e a residência médica; a complexidade da convivência cotidiana com a morte e o processo de morrer, juntamente com os sentimentos e mecanismos de defesa; a espiritualidade e a religiosidade; as afirmações de que a distanásia realmente acontece; os pedidos obstinados da família do paciente terminal internado na UTI; as grandes complexidades das tomadas de decisão, que se iniciam desde antes da admissão do paciente na UTI, passando pelas dúvidas em relação ao investimento, ou não, no mesmo e nos critérios utilizados para se saber até onde investir; o papel da equipe nas tomadas de decisão; o enorme receio das repercussões éticas e legais em relação às decisões tomadas, no que se refere aos códigos de ética profissional e o Código Penal brasileiro, além das ausências e eufemismos empregados nos registros de diagnóstico, prognóstico e cuidado ofertado ao enfermo terminal; e, por fim, os anseios de boa morte para o próprio profissional e seus familiares, com desejos de falecer em casa, junto com a família, como forma de aceitação da sua finitude. Concluiu-se, neste estudo, que existem necessidades de aperfeiçoamento no que tange a múltiplos aspectos referentes à morte: sua abordagem, na graduação e residência; comunicação adequada entre os profissionais durante os processos decisórios e durante o trabalho na UTI; a ponderação entre os desejos da família e as reais possibilidades de sobrevivência do doente. É importante se colocar no lugar do doente e considerar que, em uma hipotética terminalidade de vida, tudo o que o profissional dispensa ao paciente dentro de uma UTI é tão somente aquilo que não desejaria, como morte digna, para si ou familiares.

By implementing Albert O. Hirschman’s theory about reactions, the purpose of this thesis is to analyse the arguments against carbon offsetting presented in Swedish media. More specifically, I will structure and analyse the counter-arguments I find in the articles about carbon offsetting presented by the Swedish paper Dagens Nyheter between October 2019 and January 2020. Hirschman’s theory of the reactionary rhetoric is based on the notion that every social action is followed by a reaction. To illustrate this, Hirschman introduces three types of theses –arguments -deployed by those who oppose a new idea or reform. The three principal arguments Hirschman identifies is the futility thesis, the perversity thesis and the jeopardy thesis. The futility thesis suggests that an action aiming to improve the society in any way won’t have any effect, the perversity thesis claims that the action will result in the opposite outcome of what was intended and the jeopardy thesis implies that the action will result in intolerable consequences in other areas. Hirschman suggests that a debate where any of these theses are present both is a danger for democracy and is likely to result in suffering in other ways as well. In that way, his theory provides a tool for identifying dangerous arguments in order to take a step towards a more democracy friendly discussion. By analysing 85 arguments against carbon offsetting I find that 51 of them easily can be categorized as either one of the theses, while 22 can’t be categorized at all. The remaining 12 arguments can either partly or in full be placed in the model. The majority of the 51 arguments fitting in Hirschman’s model are futility theses, which implies that the Swedish debate in this area largely consists of arguments claiming that carbon offsetting doesn’t make any difference. My conclusion based on Hirschman’s theory and the analysis of the arguments is that the Swedish debate about carbon offsetting unarguably contains signs of the polarized discussion Hirschman claims to be a democratic danger and that both the debate itself and the climate overall probably would benefit from a more nuanced and balanced debate.

Although provision of palliative care on the United States is growing, referrals to the service are often late or non-existent. The simultaneous care model provides a blueprint for the most progressive form of palliative care, which is palliation and disease-oriented treatments delivered concurrently. Research indicates the existence of a widespread misconception that associates palliative care with imminent death, and some organizations have chosen to re-brand their palliative care services to influence this perception. The goal of this study was to assess the effects of a name change from palliative care to supportive care on the communicative process during referrals to the service.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This research aimed to know as the physicians of the Neonatal and Pediatric Intensive Care Units (ICU) mean the dysthanasia. The specific objectives sought to identify the impact of the children's death to the physician; to understand like they live the difficulty of a child's cure; and to understand as the physician of the Neonatal and Pediatric Intensive Care Units identify their preparation to work with situations of life end in children. For so much, it was used an exploratory/descriptive study, of qualitative approach. Participated in the research 6 physicians and 5 residents, belonging to the Neonatal and Pediatric Intensive Care Units. As instrument for the data collection it was used a semi-structured interview. The information of the interviews was transcribed and analyzed starting from the content analysis. The ethical principles were respected, so that the participants rights were preserved, and an Informed Consent Document was signed as a condition to participate in the research. Among the results, it was observed that the physicians mean the dysthanasia in Neonatal and Pediatric Intensive Care Units under influence of multiples factors, leaving of the absence of the teaching and preparation to work with the death in the hospital daily during the graduation; the complexity of the daily coexistence with the death and the process of dying, together with the feelings and defense mechanisms; the statements that the dysthanasia really happens; the obstinate requests of the terminal patient's family interned in ICU, are going to have doubts in relation to the investment, or no, in the same and in the criteria used to know if they apply investing; the divergences of the team in the sockets of decision; the enormous fear of the ethical and legal repercussions in relation to the taken decisions, in what refers to the codes of practice and the Brazilian Penal code. It was ended, in this study, that improvement needs exist with respect to multiple aspects regarding the death: their approach, in the graduation and residence; appropriate communication among the professionals during decision making process and during the work in ICU; the consideration between the desires of the family and the real possibilities of survival of the patient. / Esta pesquisa objetivou conhecer como os médicos das UTIs neonatal e pediátrica significam a distanásia. Os objetivos específicos visaram identificar o impacto emocional da morte de crianças nos médicos; entender como eles vivenciam a dificuldade de cura de uma criança; e compreender como os médicos das UTIs neonatal e pediátrica identificam o seu preparo para lidar com situações de final de vida em crianças. Para tanto, utilizou-se de um estudo exploratório/descritivo, de abordagem qualitativa. Participaram da pesquisa 6 médicos e 5 residentes, pertencentes às UTIs neonatal e pediátrica. Como instrumento para a coleta de dados, utilizou-se de uma entrevista semiestruturada. As informações das entrevistas foram transcritas e analisadas a partir da análise de conteúdo. Os princípios éticos foram respeitados, de forma a proteger todos os direitos dos participantes, com formalização da participação por meio de Termo de Consentimento Livre e Esclarecido. Dentre os resultados, observou-se que os médicos significam a distanásia em UTI pediátrica e neonatal sob influência de múltiplos fatores, partindo da ausência do ensino e preparação para lidar com a morte no cotidiano hospitalar durante a graduação; a complexidade da convivência cotidiana com a morte e o processo de morrer, juntamente com os sentimentos e mecanismos de defesa; as afirmações de que a distanásia realmente acontece; os pedidos obstinados da família do paciente terminal internado na UTI, passando pelas dúvidas em relação ao investimento, ou não, no mesmo e nos critérios utilizados para se saber até onde investir; as divergências da equipe nas tomadas de decisão; o enorme receio das repercussões éticas e legais em relação às decisões tomadas, no que se refere aos códigos de ética profissional e o Código Penal brasileiro. Concluiu-se, neste estudo, que existem necessidades de aperfeiçoamento no que tange a múltiplos aspectos referentes à morte: sua abordagem, na graduação e residência; comunicação adequada entre os profissionais durante os processos decisórios e durante o trabalho na UTI; a ponderação entre os desejos da família e as reais possibilidades de sobrevivência do doente.

Background: Since the 60s and with increasing intensity a discussion have continued about balance between useful and useless/harmful treatment. Different attempts have been done to create sustainable criteria and recommendations to manage the situations of futile treatment near the end of life. Obviously, to be able to withhold (WH) or withdraw (WD) treatment which is no longer appropriate or even harmful and burdensome for the patient, other processes than strict medical (or physiological) assessments are necessary. Aim. To shed light on the arguments regarding to WH or WD futile treatment we performed two studies of physicians’ and the general populations’ choice and prioritized arguments in the treatment of a 72-year-old woman suffering from a large intra-cerebral bleeding with bad prognosis (Papers I and II) and a new born boy with postpartum anoxic brain damage (Papers III and IV). Methods. Postal questionnaires based on two cases presented above involving severely ill patients were used. Arguments for and against to WH or WD treatment, and providing treatment that might hasten death were presented. The respondents evaluated and prioritized arguments for and against withholding neurosurgery, withdrawing life-sustaining treatment and providing drugs to alleviate pain and distress. We also asked what would happen to physicians’ own trust if they took the action described, and what the physician estimated would happen to the general publics’ trust in health services (Paper IV). Results. Approximately 70% of the physicians and 46% of the general public responded in both surveys. The 72-year-old woman: A majority of doctors (82.3%) stated that they would withhold treatment, whereas a minority of the general public (40.2%) would do so; the arguments forwarded and considerations regarding quality of life differed significantly between the two groups. Quality-of-life aspects were stressed as an important argument by the majority of both neurosurgeons and ICU-physicians (76.8% vs. 54.0%); however, significantly more neurosurgeons regarded this argument as the most important. A minority in both groups, although more ICU-physicians, supported a patient’s previously expressed wish of not ending in a persistent vegetative state as the most important argument. As the case clinically progressed, a consensus evolved regarding the arguments for decision making. The new born child: A majority of both physicians [56 % (CI 50–62)] and the general population [53 % (CI 49–58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient’s symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions. Conclusions. There are indeed considerable differences in how physicians and the general public assess and reason in critical care situations, but the more hopelessly ill the patient became the more the groups' assessments tended to converge, although they prioritized different arguments. In order to avoid unnecessary dispute and miscommunication, it is important that health care providers are aware of the public's views, expectations, and preferences. Our hypothesis—physicians’ estimations of others’ opinions are influenced by their own opinions—was corroborated. This might have implications in research as well as in clinical decision-making.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Sept. 23, 2008). Includes bibliographical references.

Jan Amos Komenský is a great figure of the Czech nation. However, despite his fame, he is a much more significant thinker than he is generally regarded to be. Labyrinth of the World and Paradise of the Heart has no equivalent in its time or in older Czech literature. Even if Komenský wrote nothing else, this book would guarantee him a prominent place in Czech literature. In Labyrinth, Komenský shows himself as a great believer who exactly uncovers human pride, uncovers imaginary and untrue independence of man and shows exactly and aptly the futility and true face of many human endeavours. Labyrinth is a merciless criticism of man. It is never nihilistic, though {--} it is always based on a deep and realistic sense of purpose, a deep feeling for the ethical. That is why Komenský{\crq}s irony {--} which is the essential accord of Labyrinth {--} is irony of sadness. Some of Komenský{\crq}s ideas are close and understandable to us; however, some are much more distant. It remains a question if what seems to us to be old, outdated or naive in Komenský, is a basis without which it is not possible to understand well and realize what we are no longer willing to identify with. Is the ``critic of rationalism{\crqq} and great believer in Komenský, so distant to us, his most important basis that gives viability and future to his own ideas as well as to all human endeavours? This work briefly describes the ideas and storyline of Komenský{\crq}s Labyrinth. Each chapter of this thesis attempts to find what is most important in the mass of text of Labyrinth and thus to briefly point out the significance of each part of the book. Sometimes exact quotations are used which should show the real sense of Komenský{\crq}s ideas in a better way. Quotations from the Bible which could be a base of Komenský{\crq}s ideas are matched to individual chapters. The attempt is to find those ideas of Komenský which could be used and could be useful in our society. On the basis of an elaboration on the book, this work attempts to point out the importance of real belief and keeping to its rules for the life of a man and a society as a whole.

RATIONALE & OBJECTIVE: Patients receiving maintenance dialysis have higher mortality after primary percutaneous coronary intervention (pPCI) than patients not receiving dialysis. Whether pPCI confers a benefit to patients receiving dialysis that is similar to that which occurs in lower-risk groups remains unknown. We compared the effect of pPCI on in-hospital outcomes among patients hospitalized for ST-elevation myocardial infarction (STEMI) and receiving maintenance dialysis with the effect among patients hospitalized for STEMI but not receiving dialysis. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: We used the National Inpatient Sample (2016-2018) and included all adult hospitalizations with a primary diagnosis of STEMI. PREDICTORS: Primary exposure was PCI. Confounders included dialysis status, demographics, insurance, household income, comorbidities, and the elective nature of the admission. OUTCOME: In-hospital mortality, stroke, acute kidney injury, new dialysis requirement, vascular complications, gastrointestinal bleeding, blood transfusion, mechanical ventilation, palliative care, and discharge destination. ANALYTICAL APPROACH: The average treatment effect (ATE) of pPCI was estimated using propensity score matching independently within the group receiving dialysis and the group not receiving dialysis to explore whether the effect is modified by dialysis status. Additionally, the average marginal effect (AME) was calculated accounting for the clustering within hospitals. RESULTS: Among hospitalizations, 4,220 (1.07%) out of 413,500 were for patients receiving dialysis. The dialysis cohort was older (65.2 ± 12.2 vs 63.4 ± 13.1, P < 0.001), had a higher proportion of women (42.4% vs 30.6%, P < 0.001) and more comorbidities, and had a lower proportion of White patients (41.1% vs 71.7%, P < 0.001). Patients receiving dialysis were less likely to undergo angiography (73.1% vs 85.4%, P < 0.001) or pPCI (57.5% vs 79.8%, P < 0.001). Primary PCI was associated with lower mortality in patients receiving dialysis (15.7% vs 27.1%, P < 0.001) as well as in those who were not (5.0% vs 17.4%, P < 0.001). The ATE on mortality did not differ significantly (P interaction = 0.9) between patients receiving dialysis (-8.6% [95% CI, -15.6% to -1.6%], P = 0.02) and those who were not (-8.2% [95% CI, -8.8% to -7.5%], P < 0.001). The AME method showed similar results among patients receiving dialysis (-9.4% [95% CI, -14.8% to -4.0%], P < 0.001) and those who were not (-7.9% [95% CI, -8.5% to -7.4%], P < 0.001) (P interaction = 0.6). Both the ATE and AME were comparable for other in-hospital outcomes in both groups. LIMITATIONS: Administrative data, lack of pharmacotherapy and long-term outcome data, and residual confounding. CONCLUSIONS: Compared with conservative management, pPCI for STEMI was associated with comparable reductions in short-term mortality among patients irrespective of their receipt of maintenance dialysis.