T.H. wants to know whether he "has to be put on a breathing machine." What factors will you

Question

take into consideration when deciding what to tell him?

What will be an ideal response?

Answer 1

Like all ALS patients, at some point T.H. will require respiratory support and will eventually face the
difficult choice of deciding whether he will accept mechanical ventilation. The nurse must clearly
communicate the inevitability of complete dependency on mechanical ventilation. Although
mechanical ventilation will enable the patient to breathe and prolong survival, it does not alter
progression of the disease. For this reason, many patients elect not to be placed on a mechanical
ventilator. Encourage patients to discuss this with family and friends and to seek input from ALS
support groups. Encourage patients to complete advance directives to indicate their desires for
mechanical ventilation and other life-sustaining treatments. Reassess his plans periodically. Patients
might change their minds based on their illness experience, changes in their subjective appreciation
of their quality of life, or changes in their evaluation of the benefits and burdens of life-sustaining
measures as they come to terms with the imminence of death.