Abstract: For the treatment of chronic renal failure, nephrologists should avoid the "one-size-fits-all" dialysis program, consider the patients' quality of life, contextual features, respect patients' preference, and recognize the importance of patients' participation in determining the goal and clinical decision. Based on the "Four Topics Theory" of clinical ethics and the medical ethical principles through an example of a patient that refused hemodialysis for chronic renal failure, this article explores the ethical issues related to the choice of treatment for patients with chronic renal failure. The clinical decision should combine the patient's preference and the best quality of medical care, which ultimately achieves a medical model of patient-centered and shared decisionmaking.