Background Conventional hemodialysis has become a life-sustaining treatment for ESRD patients. However, uncertain conditions change, and long-term dialysis among hemodialysis patients has also become a great burden and life stress. Facing possible changes and deterioration of their future condition, and based on their value differences in perspectives and thinking, end of life medical decisions concerning the withdrawal of hemodialysis may vary from person to person.

Aim To investigate the situations hemodialysis patients consider about withdrawing hemodialysis.

Methods A semi-structured interview was implemented to communicate with seventeen hemodialysis patients, and analysed using content analysis.

Results Results revealed six themes of status from patients’ perspective: poor quality of life, inability to take care of themselves, bad effects of dialysis, terminal stage with multiple organ failure, coma and no longer wake up, and wait for death.

Discussion According to the results, viewpoints of medical decisions are derived from different life experiences and value beliefs. Quality of life, self-care ability, dialysis efficacy, organ function, and the state of consciousness until death, show hemodialysis patients’ different expectations on existence and determination to defend the privilege of autonomy. While caring for dialysis patients, medical professionals should act proactively on advance care planning to understand the patient’s perspective and wishes, facilitate the signing of advanced directives, and highlight patient’s autonomy in medical decisions.

Conclusion Therefore, we must communicate on a health care plan to understand patients’ thoughts on withdrawing hemodialysis, help them to make decisions aligned with their personal values and beliefs and promote the quality of end of life care.