ABSTRACT
Most regular dialysis patients die a cardiovascular death. A significant minority elect to discontinue treatment owing to an unacceptably poor quality of life or for other reasons. This may or may not pose a major ethical dilemma for the nephrologist. The current ethical belief is that the decision should rest with the patient, providing he or she is competent to make it. The notion that failure to provide dialysis at the request of an informed and competent patient might be illegal has not been tested in the courts. It is the responsibility of the physician to ensure that the patient is competent to decide. For example, treatable severe depression should be excluded and, if possible, treated before a decision to cease dialysis treatment is accepted. In the final analysis, however, one cannot force dialysis treatment upon an unwilling patient.
