Last resort options for refraktory suffering

Case study of the patient with amytrophic lateral sclerosis

Abstract

Abstract

The case report describes the course of the disease in a 74-year-old woman with amyotrophic lateral sclerosis in an inpatient hospice. At a certain stage of the disease associated with a rapid loss of self-sufficiency, the patient began to experience significant existential suffering and demanded palliative sedation for the rest of her life. Due to the absence of physical symptoms and the estimated prognosis of weeks to months, this solution was not acceptable for the hospice staff. After consulting with a clinical ethicist, the hospice team suggested to the patient the option of "voluntary stopping eating and drinking" and at the same time stopping administering fluids to PEG. The patient chose this option and died peacefully in the following days. The case shows the decision to "voluntarily stop eating and drinking" and withdraw of artificial hydratation as an ethically and legally acceptable solution to the refractory suffering in advanced incurable disease, but it also aims to provoke a discussion of the dilemmas that come with it.