126 Romanian Journal of Bioethics, Vol. 10, No. 1, January - March 2012 END OF LIFE ETHICAL ISSUES IN PATIENTS WITH END - STAGE RENAL DISEASE Diana Moldovan*, Ioan Moldovan ** Crina Rusu ***, Ina Kacso**** Liliana Prvu****, Mirela Gherman - Căprioară***** Abstract The ethical dilemma of decision-making at the end of the life of ESRD patient raise important ethical dilemma for the nephrologists. Although dialysis and renal transplantation represent successful treatment for ESRD, there are still patients whose clinical features raise the problem if the initiation or continuation of dialysis is an adequate approach. This is a literature review analysing the ethical aspects for adult patients suffering from ESRD in their final stage. MEDLINE database was searched for representative articles using the following keywords: !withholding withdrawal dialysis ethical issues". As a basic principle, all ESRD pacient should have the opportunity to benefit from dialysis. Although, in patients suffering from a terminal illness, withholding or withdrawal of dialysis could represent a mean to refuse treatments that only postpone the imminent death. Yet, this approach has the risk to be misinterpreted as euthanasia. That#s why counseling, adequate information, timely health care decision making are real necessities. Advance directives in nephrology regarding specific aspects of life and death could contribute to a $good death" and could prevent ethical problems. Keywords: ethics, end-stage renal disease, chronic dialysis, dialysis refusal. * Primary nephrologist, assistant professor in nephrology, !Iuliu HaĠieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania, e-mail: Diana.Moldovan@umfcluj.ro ** Primary pneumologist, Chief of the section, Emergency Military Hospital Cluj-Napoca, Romania *** Primary nephrologist, assistant professor in nephrology, !Iuliu HaĠieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania **** Primary nephrologist, academic papers coordinator, !Iuliu HaĠieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania ***** Professor in nephrology, !Iuliu HaĠieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania