For many people with kidney failure, dialysis and transplantation greatly improve the quality of life. For some patients, dialysis and transplantation may not work as effectively or be an option, often because of a combination of serious health problems. It is important to know that patients have the right to decide not to start dialysis or refuse treatments. Before considering this option, patients should discuss it carefully with their doctors and loved ones. When patients decide not to start treatment, or discontinue dialysis, the patient or the person designated to make medical decisions may want to make sure the following items are in order: a will, and a signed advance directive (living will, durable health care power of attorney or health care proxy) that complies with state law.