THIS IS an interesting study regarding a unique form of euthanasia,1 and it addresses an important and underemphasized issue of quality of death for patients after discontinuation of dialysis. There has been a marked increase in dialysis withdrawals during the past few years.2 At the start of the Medicare End-Stage Renal Disease Program in 1972, the dialysis population usually consisted of young and, apart from renal disease, healthy patients. However, patients currently undergoing dialysis have relatively poorer quality of life and are older.3,4 Accordingly, more withdrawals are anticipated in the future.
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Although the authors found that most patients had a "good death" as ascertained by various subjective scoring techniques, several patients appeared to have a "painful ending" related to pain control and comfort measures. This information is important not only because it raises an issue in the care of patients with dialysis discontinuation