[Withdrawal from dialysis: a frequent but sometimes difficult situation]

Withdrawal from dialysis is a frequent cause of death in chronic dialysis patients in a French population, as it is in North America. In both populations dialysis was withdrawn in about 20%, but the characteristics of patients and the decision-making procedure were different. In France, patients in whom dialysis was withdrawn were most often at the end of their life, and the physician essentially made the decision. This decision was often difficult to make and be accepted, particularly when the patient chose himself to stop the dialysis, even if life expectancy would be long on dialysis. A discussion including the patient, his family and the medical staff is crucial. The modification of the French law about the rights of patients at the end of their life will be assistance when such decisions take place, especially in non-conscious patients who are at the end of their life, and in those who want to stop dialysis. Philosophical and ethical reflection with its concepts for autonomy and dignity can be a valuable aid in such situations.