A critically ill infant, child, or adolescent is rapidly deteriorating. The patient has kidney failure resulting in volume overload, metabolic disturbance, or both. A call is made to the pediatric nephrology service. The inevitable question is: “would you offer dialysis to this patient?” As a nephrologist, I find that I have increasing difficulty responding to this question. As I reflect on this difficulty, I realize that a great deal of the challenge in finding an answer is embedded in the wording of the question.