End stage renal disease (ESRD) patients can achieve a "good death" when planning is combined with an ethic of care. Advance directives can help to ensure that patients who want to participate in their treatment decisions may do so. An ethic of care ensures that the actual process of dying incorporates important factors such as readiness to die, appropriate interpretation of advance directives in terminal clinical situations, and proper timing of death. Nephrology nurses can play key roles in ensuring that patients die comfortably.