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DOI: 10.1055/s-2007-987545
The wish to hasten death among ALS patients in a palliative care program
Aim: Amyotrophic lateral sclerosis (ALS) represents a major challenge to palliative neurological management, particularly as the characterics of the disease may provoke patients' wishes to hasten death. The study investigated the prevalence and determinants of the wish to hasten death in ALS patients and the views of their caregivers.
Methods: The semi-quantitative questionnaire study included patients and their primary caregivers treated in an outpatient ALS clinic in Munich, Germany, between April 2005 and August 2006.
Results: The study comprised a sample of 30 patient-caregiver-pairs. 31% of patients expressed the desire to hasten death. Suicidal ideation was admitted by 50%, while 24% had planned and 6% actually tried suicide. 44% of patients could imagine asking their doctor for physician-assisted suicide or euthanasia. The desire to hasten death correlated significantly with loneliness and both the depression and anxiety subscales of the Hospital Anxiety and Depression Scale, but not with religiosity as measured by the Idler Index of Religiosity. Only 11% of primary caregivers said their relatives communicated with them about hastening death. 25% and 20% of caregivers could imagine assisting in suicide or performing euthanasia, respectively.
Conclusions: The wish to hasten death is common among German ALS patients in a palliative care setting. Its correlations with loneliness, anxiety and depression pose challenges to palliative care. Neurologists and palliative care physicians should address wishes for hastening death more openly and be ready to diagnose and treat correlated conditions like anxiety and depression.