Offering patients life-prolonging treatments while at the same time improving their quality of life is a balancing act. With time, we learn that more care is not necessarily good care, that not every test or treatment available to the patient is needed, and that, at times, they may cause more harm than good.
A clinician must judge which treatment is quantitatively futile (it simply cannot physiologically work) or inappropriate. The latter is a gray zone and at times takes into consideration the clinicians’, patients’, and surrogates’ personal conceptions about life and treatment goals. One such treatment is dialysis in a