Exit strategies in ALS
An influence of depression or despair?
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How common is depression in people with ALS as they approach the end of life? How often do these people strategize about the way they will exit life? Most importantly, are people who plan to hasten the end of their lives usually depressed, and does effective treatment of depression reduce this planning?
Variable frequencies of depression and hopelessness have been reported in previous studies of ALS. None of these has been longitudinal at the end of life in ALS. Attitudes toward death and the desire to hasten death have been investigated rarely. The early Oregon experience suggested that a majority of people with ALS are interested in physician-assisted suicide as an option.1 In the Netherlands, one in five patients with ALS died as a result of euthanasia or physician-assisted suicide.2
In this issue of Neurology, two important articles address prospectively end-of-life issues in ALS. Both investigations studied the same population of 80 ALS patients, who were followed at monthly intervals once their forced vital capacity (FVC) dropped to 50% of predicted. This FVC identifies a point at which survival is usually <6 months. Both articles report on the 53 patients who died during …
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