It is usually left up to the family and they can't let poor Grandma go. Yet, they are too busy to stop and see her or help her out or god forbid stay with her at dialysis. I think it is up to the doctors to stress that dialysis would be more 'harm' than good to an aging relative who cannot think or speak for themselves.
If Grandma is 92 and wants dialysis and understands the process then that is a different story.
To me if you don't know your are even at dialysis, then you don't know or understand why you feel bad.
My understanding is kidney failure is not a bad death. Your toxins build up and you go to sleep and never wake up.