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

机译：Euthanasia和医生辅助自杀患者肌营养的外侧硬化症（临床案例的文献和描述）

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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.Purpose of the study. 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 research 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 of the investigation and their 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.
机译：介绍。肌萎缩侧索硬化症是导致肌肉麻痹和萎缩，由于上，下运动神经元变性的中枢神经系统的缓慢进行性变性polyetiological不治之症。由于本病通常不会影响认知能力，患者都知道的功能逐渐丧失，并可能会变得急躁，陷入抑郁症。对别人的依赖是难以忍受的痛苦，社会心理原因，迫使患者问医生通过安乐死或医生协助自杀的手段来加速他们的死亡。对于安乐死的患者比例高肌萎缩侧索硬化症一种可能的解释是缺乏姑息替代品。这就是为什么需要前瞻性研究，探讨姑息治疗之间可能存在的联系，在医生的角色，生活质量，病人的动机和这些病人结束生命的医疗决定。这项研究的目的。要分析现在才公布有关安乐死和医生协助自杀患者的肌萎缩侧索硬化症的研究，并描述这些患者的替代监管手段的临床病例。材料和研究方法。我们在以前工作多年的临床研究数据和分析特定病人谁是我们的观察下的疾病的情况。调查和他们的讨论结果。是谁选择安乐死和医生协助自杀患者的比例是20.0％，其中17.0％的人选择安乐死，3.0％， - 医生协助自杀。请求安乐死的最重要的原因是：害怕窒息（45.0％），依存度（29.0％），尊严（20.0％）的损失，言语（16.0％）的呼吸/困难等，怕依赖（14.0％） ，（45.0％），依赖（29.0％），尊严（20.0％）的损失。疾病的阶段，在医生协助死亡与安乐死比较的那一刻度残疾（手臂和腿的动作和语言功能）进行了评价。在疾病患者晚期往往同时医生协助自杀的早期阶段发生更频繁地选择安乐死。正确的信息有关可能死亡的因窒息减少和防止可以减少他们的恐惧，减轻他们的痛苦和对高安乐死率影响方式的患者。如果死亡的愿望是绝望引起的，宗教可以有助于减轻它。连续深度镇静是肌萎缩侧索硬化症中比较常见，似乎成为安乐死和医生协助自杀的替代品。其中，安乐死是不合法的国家更无创通气。研究对带有肌萎缩侧索硬化症转基因小鼠模型环孢菌素A的影响发现，它延伸的小鼠的寿命与该疾病与对照组进行比较。这一发现目标，影响患者的肌萎缩侧索硬化症线粒体的功能，并且可以延长人的生命重要。根据我们的经验，利鲁唑，心理帮助，家人的支持帮助治疗，以改善患者的心理状态，减少焦虑，抑郁和防止选择安乐死。结论。据研究的回顾性分析获得的信息，在2015年出版的，谁选择安乐死和医生协助自杀的患者比例较高，达20.0％。但是，我们的临床经验表明，宗教和心理支持亲属和医生的帮助下将利鲁唑，减少绝望和背部有希望的生活，患者可避免选择安乐死和医生协助自杀。

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