Islamic law permits the withdrawal of life-sustaining treatment, including dialysis if it is in the patient’s best interests. In this instance withdrawal of life-sustaining treatment is seen as allowing death to take its natural course. Suicide and euthanasia are against Islamic law. Hinduism is a broad range of beliefs with rich traditions. A common belief is that death leads to reincarnation, life in heaven or absorption into Brahman (the ultimate reality). Suffering, including an illness such as ESKD may be seen as punishment for wrongs committed in the past.

A good death is an important part of spiritual life. Broadly this is defined as dying in old age, having resolved conflicts, said goodbye and having placed all one’s affairs in order. A bad death is untimely, violent and unprepared. Some Hindus will fast as they approach death as purification of body and spirit. There may be tension between open disclosure to INCB024360 in vitro allow a person to prepare for death and the desire of the family to protect the loved one. Analgesia

and sedation may be declined in order to maintain a clear mind. Buddhism preaches the inevitability of death. ‘Buddhists tend to be psychologically prepared to accept impending death with calmness and dignity’.[1] The withdrawal of treatment, including dialysis, is acceptable. In Buddhism there is an emphasis on mindfulness and mental clarity. To that end, Buddhists may decline analgesia or sedation with the belief that dying with an unclouded mind can lead to a better rebirth. Individuals are encouraged to follow their own conscience BYL719 Branched chain aminotransferase in decision-making as there is no central authority competent to pronounce on matters of ethics or doctrine. For an excellent series on the

views of the major religions on end of life care and death see: Lancet: Viewpoint series: End of life issues for different religions. Lancet 2005; 366: 682–6, 774–9, 862–5, 952–5, 1045–8, 1132–5, 1235–7. Brian Siva and Frank Brennan A core competency of Nephrology should be the capacity to diagnose dying. Withdrawal of dialysis is ethically and legally valid. It is a fundamental tenet of medical practice that a careful balance should be always made between the benefits and burdens of any treatment.[1] Far from being static, this is a dynamic process. That is especially so when the condition of the patient is rapidly and irreversibly changing and where a treatment that was once considered absolutely beneficial is now of no or marginal benefit only. In the context of end-stage kidney disease (ESKD) this process of dynamic decision-making reflecting the dynamic of the clinical circumstances of the patient is extremely important. Multiple issues may unfold – related or unrelated to the underlying ESKD and its management – that may alter the clinical circumstances necessitating a review of all treatment.