Euthanasia and Physician-assisted Suicide in Patients with Amyotrophic Lateral Sclerosis (Review of the Literature and Description of a Clinical Case)

Introduction. Amyotrophic lateral sclerosis is a slowly progressive degenerative polyetiological incurable disease of the central nervous system which causes muscle paralysis and atrophy due to the degeneration of the upper and lower motor neurons. As the disease doesn't usually affect cognitive abilities, the patients are aware of the progressive loss of function and may become irritable and fall into depression. Dependence on other people is a psycho social reason of unbearable suffering, forcing patients to ask a doctor to hasten their death by means of euthanasia or physician-assisted suicide. A possible explanation for the high proportion of euthanasia in patients with amyotrophic lateral sclerosis may be the lack of palliative alternatives. That is why the prospective studies are needed to explore possible links between palliative care, the role of a doctor, quality of life, patient's motivation and end-of-life medical decisions of these patients. Aim. To analyze the studies published until now on euthanasia and physician-assisted suicide in patients with amyotrophic lateral sclerosis and to describe the clinical case of those patients alternative supervision tactics. Materials and methods. We have worked on previous years clinical research data and analyzed a case of the disease of a particular patient who was under our observation. Results and discussion. The percentage of patients who choose euthanasia and physician-assisted suicide is 20.0 %, 17.0 % of them choose euthanasia, 3.0 % - physician-assisted suicide. The most important reasons for requesting euthanasia were: fear of suffocation (45.0 %), dependence (29.0 %), loss of dignity (20.0 %), shortness of breath / difficulty of speech (16.0 %), fear of dependence (14.0 %), (45.0 %), dependence (29.0 %), loss of dignity (20.0 %). The stage of disease and a degree of disablement (arm and leg movements and a language function) at the moment of physician-assisted dying comparing with euthanasia were evaluated. In the late stages of the disease patients tend to choose euthanasia more often while physician-assisted suicide occurs in the early stages. Proper information for the patients about the decrease of possible dying due to suffocation and the ways to prevent that can lessen their fear, ease their suffering and have impact on the high euthanasia rate. If the desire for death is caused by despair, religion can help to lessen it. Continuous deep sedation is relatively common among patients with amyotrophic lateral sclerosis and appears to become an alternative to euthanasia and physician- assisted suicide. The countries where euthanasia is not legal prefer noninvasive ventilation. Research on influence of cyclosporine A on transgenic mouse model with amyotrophic lateral sclerosis discovered that it extends life of mice with this disease comparing with the control group. That discovery aims to influence the function of mitochondria in patients with amyotrophic lateral sclerosis and may be important for extending human life. According to our experience, treatment with riluzole, psychological help, family support help to improve psychological state of patients, reduce anxiety, depression and prevent choosing euthanasia. Conclusions. According to the information obtained by retrospective analysis of the studies, published by 2015, the proportion of the patients who choose euthanasia and physician-assisted suicide is high and amounts to 20.0 % . But our clinical experience shows that by applying riluzole, lessening despair and having back hope for life with the help of religion and psychological support of relatives and doctors, patients can avoid choosing euthanasia and physician-assisted suicide.