Fig. 1

Decision-making process when renal replacement therapy becomes necessary [4]. *1: When consensus is not reached among the patient, family, and healthcare team, the team will consult with the head of the facility to hold a nonregular committee comprising multiple specialists including a doctor, nurses, clinical engineers, and a healthcare ethics specialist or a standing ethics committee. This committee advises the team, which aims to reach consensus with patients and their families. Depending on the situation, a conference can be held by medical staff and long-term care workers other than the doctor, nurse, and clinical engineer in charge. *2: Reasons for the temporary decision to forgo dialysis that are solvable concern patient suffering that can be addressed through appropriate intervention (e.g., difficulties visiting a healthcare facility, hypotension during dialysis, and piercing pain)