BACKGROUND:

Technological advances continue to yield life-prolonging treatments that complicate the occurrence of death. Until recently, refusal to submit to recommended care was considered suicide. OBJECTIVE:

Physicians must now decide how to respond to requests for hastened dying. METHOD:

The authors propose a four-square grid distinguishing true suicide from behaviors such as treatment termination and lethal noncompliance. RESULTS:

One axis characterizes whether actions hasten death. The other identifies how the patient's social and medical network collaborate in the decision-making process. CONCLUSION:

Using chronic kidney disease to model intent and collaboration, treatment is framed within a paradigm that reflects both end-of-life decision-making complexities and contemporary conceptualizations of suicide.