47

Amyotrophic lateral sclerosis (ALS) is an incurable neurodegenerative disease. It increases an individual’s dependence as it evolves and requires the use of life-saving substitution techniques. Palliative care can be used, but this comes later, and there are real legal and ethical issues that need to be addressed early when it comes to this type of care. The creation of an advance directive (AD) enables the patient’s autonomy to be respected. However, serious disease makes it difficult to create an AD. Informing patients about both curative and palliative therapeutic options can facilitate the expression of their wishes. An early palliative approach in ALS facilitates dialogue about the end of life and could also facilitate the choices of both the patient and the physician.