Nephrologists are expected to play a role in this determination, but all too often the nephrologist, like other physicians, must be prompted to deal with end-of-life issues. If no one is available to do the prompting, the patient's death may be needlessly prolonged. The amount to which the nephrologist takes on end-of-life care will be reflected in their approach to the patient. At one end of the spectrum, discomfort with dying can lead to passivity, where the nephrologist serves purely passive role, overseeing dialysis and focusing on fluid and electrolyte balance. At the other end, the nephrologist can be seen as taking a leading role in end of life care (Siegler, Del Monte, Rosati, and von Gunten, 2002).

Chronic diseases are now thought to be the leading causes of death around the world. The World Health Organization (WHO) has reported that there were approximately 58 million deaths worldwide in 2005,...
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