Ethical and legal aspects of end of life in dialysis patients: an Italian point of view.

In the Western world, thanks to continuous progress in the medical field, and to changes in society, the concept of death seems to be increasingly replaced by that of "keeping alive at all costs". Thus also dialysis, a life-sustaining treatment for patients suffering from kidney failure, in some cases can no longer be seen as a treatment aimed at prolonging life, but as a treatment to temporarily avert death. In fact, the literature highlights that dialysis is not always associated with greater life expectancy and better quality of life for fragile patients with kidney failure. This point-of-view paper discusses legal and ethical principles of respect for patient autonomy (beneficence, non-maleficence, justice and professional integrity) inherent in the choice to suspend or to not start dialysis treatment, while following a pathway of conservative and/or palliative therapy.