End stage renal disease by patients with malignancy--ethical problems

The problem of co-occurrence of kidney failure, as well as ESRD and malignancy is relatively often and brings a significant therapeutical and moral challenge. The ethical basis of our consideration are "Evangelium Vitae" by John Paul II and "Declaration Jura et Bona". The fundamental choice is whether to start and/or continue the kidney replacement treatment. We present 3 algorithms for the most typical situations. The first ethical postulate in our considerations is that patients with the malignancy of good prognosis should not be denied of any treatment chance and should be dialysed as any other patient. In the situation of patients with neoplastic disease with bad prognosis and ESRD, the question of 'withholding or withdrawing' dialysis is essentially part of a fundamental question, what should be the ultimate goal of medicine? There is no doubt that the person most authorized to take a decision in such a situation is the patient provided it is a conscious decision based on full information. Therefore any decision to cease treatment, even submitted at the public notary, should be verified as long as a conscious contact with a patient is possible. In the situation of continued lack of logical contact with the patient who has not left any clear disposition for such circumstances we must take the decision based on their benefit. It is more than desired that the decision acquires the approval of the patient's family but in the situation when it is not possible the doctor decide. In the doubtful cases we should take decisions "towards life".