This Article  • Full text  • PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on ISI (1)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Neurology  • Perspectives on Care at the Close of Life  • End-of-life Care/ Palliative Medicine  • Alert me on articles by topic

"Prepare for the Worst and Hope for the Best"

Amy J. Markowitz, JD; Stephen J. McPhee, MD

JAMA. 2007;298:1208.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

On July 11, 2007,¹ authors Mitsumoto and Rabkin presented the unusual case of a patient with amyotrophic lateral sclerosis (ALS) who was a prominent neurologist specializing in ALS. Amyotrophic lateral sclerosis is a devastating, terminal neurodegenerative disease with a highly predictable clinical course: as the authors state, palliative care begins at the time of diagnosis. Virtually all skeletal muscles are eventually affected and the only approved medication for ALS, riluzole, extends life by only about 2 months. Appropriate management includes physical rehabilitation to maintain motor function, nutritional and respiratory support, augmentative communication devices, and psychological support for both patients and families, especially because family members play a central caregiving role, often for extended periods. Early discussion of social, bioethical, and financial issues as well as advance directives is imperative, ideally long before deterioration in nutritional status might call for enteral feeding or . . . [Full Text of this Article]