Wish to die in end-stage ALS
Citation Manager Formats
Make Comment
See Comments
![Loading Loading](https://n.neurology.org/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif)
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Background: In retrospective studies, estimates of hastened dying among seriously ill patients range from <2% in one national survey to as much as 20% in end-stage disease cohorts.
Objective: To examine, in prospective studies, dying patients in the months before death, in order to understand the wish to die.
Methods: Patients with advanced ALS with a high likelihood of death or need for tracheostomy within 6 months were identified. Patients were assessed monthly with an extensive psychosocial interview, including a diagnostic interview for depression. Family caregivers were interviewed on the same schedule and also after patient deaths.
Results: Eighty patients with ALS were enrolled, 63% of eligible patients; 53 died over follow-up. Ten (18.9%) of the 53 expressed the wish to die, and 3 (5.7%) hastened dying. Patients expressing the wish to die did not differ in sociodemographic features, ALS severity, or perceived burden of family caregivers. They were more likely to meet criteria for depression, but differences were smaller when suicidality was excluded from the depression interview. Patients who expressed the wish to die reported less optimism, less comfort in religion, and greater hopelessness. Compared with patients unable to act on the wish to die, patients who hastened dying reported reduction in suffering and increased perception of control over the disease in the final weeks of life.
Conclusion: These findings suggest caution in concluding that the desire to hasten dying in end-stage disease is simply a feature of depression.
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)
Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here
Purchase
Individual access to articles is available through the Add to Cart option on the article page. Access for 1 day (from the computer you are currently using) is US$ 39.00. Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. Distributing copies (electronic or otherwise) of the article is not allowed.
Letters: Rapid online correspondence
- Wish to die in end-stage ALS
- Mandaville Gourie-Devi, Emeritus Professor, Institute of Human Behaviour and Allied Sciences,Dilshad Garden, Delhi-110095,Indiamgouriedevi@gmail.com
- and Senior Consultant Neurologist and Chairperson of Department of Clinical Neurophysiology, Sir Ganga Ram Hospital, New Delhi
Submitted June 29, 2006 - Reply from the Author
- Steven M. Albert, University of Pittsburgh, A211 Crabtree Hall, 130 DeSoto St. Pittsburgh, PA 15261 USAsmalbert@pitt.edu
Submitted June 29, 2006 - Wish to die in end-stage ALS
- Philip R. Kennedy, MD, PhD, Community Neurological Clinic, 3540 Duluth Park Lane, Suite 120, Duluth, Georgia 30096phlkennedy@neuralsignals.com
Submitted October 11, 2005 - Reply to Kennedy
- Steven M. Albert, University of Pittsburgh, A211 Crabtree Hall, Graduate School of Public Health, 130 DeSoto St., Pittsburgh, PA 15261smalbert@pitt.edu
Submitted October 11, 2005
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Dr. David Beversdorf and Dr. Ryan Townley
► Watch
Related Articles
Topics Discussed
Alert Me
Recommended articles
-
Articles
Disparities in perceptions of distress and burden in ALS patients and family caregiversE. E. Adelman, S. M. Albert, J. G. Rabkin et al.Neurology, May 24, 2004 -
Articles
Cross-cultural variation in mental health at end of life in patients with ALSS. M. Albert, M. Wasner, T. Tider et al.Neurology, March 26, 2007 -
Articles
Prevalence of depressive disorders and change over time in late-stage ALSJ. G. Rabkin, S. M. Albert, M. L. Del Bene et al.Neurology, July 11, 2005 -
Articles
Current management of ALSComparison of the ALS CARE Database and the AAN Practice ParameterW. G. Bradley, F. Anderson, M. Bromberg et al.Neurology, August 14, 2001