6. The End Stage – Final Farewell to ALS
The final stage of ALS is a testament to the profound physical impact of this disease. By Stage 6, most bodily functions cease to work, leaving patients reliant on medical interventions and caregiver assistance for survival.
However, the cognitive functions, the aspects of the mind that hold memories, personality, and the essence of who a person is, remain intact. This allows for meaningful interactions, even as the body succumbs to the disease.
In this stage, the focus of medical intervention shifts from attempting to slow the progression of the disease, to providing comfort and preserving dignity. This is where palliative care steps in, offering treatments aimed at managing pain and discomfort, and improving quality of life.
In the final stages of ALS, end-of-life decisions become a significant aspect of the patient’s journey. These decisions, though uncomfortable to contemplate, are crucial and often bring about a sense of control in patients over their care and treatment. Advanced care planning involves discussions about resuscitation efforts, ventilator use, feeding tube placement, and the like.
It’s at this stage that many patients and their families opt for a ‘Do Not Resuscitate’ (DNR) or ‘Allow Natural Death’ (AND) order. These decisions can provide peace of mind to the patients, allowing them to choose quality of life over life-prolonging interventions. (6)
