Critically ill chronic renal failure patients are maintained and sustained using numerous complex modem technologies, including dialysis. The ethical question that care providers must answer in order to be accountable to the patient and society is: “Am I using dialysis to sustain life or to prolong?” To assist clinicians in exploring this question more explicitly, the following are included in this article: a perspective on the costs associated with dying in the hospital; physiologic and psychologic criteria that have been proposed to help guide dialysis discontinuation; components related to patient autonomy; a brief overview of related ethical principles, decision-making models, and dilemmas; and a perspective on patient advocacy in relation to the question posed.