ALSの在宅終末期ケアの現場より

Managing End-of-Life Care in ALS and Its Associated Issue

筋萎縮性側索硬化症（amyotrophic lateral sclerosis：ALS）は，神経疾患のなかでも終末期の苦痛緩和が必要となる代表的疾患である。在宅患者の看取りを行っている在宅医の立場から，医療処置の選択の問題，終末期の苦痛と頻度，苦痛緩和の方法，在宅でのターミナルケアの実際について述べ，症例を提示し，在宅でのターミナルケアの必要性や問題点について述べた。

Abstract

The neurological disease amyotrophic lateral sclerosis (ALS) requires pain palliation during end-of-life stages. From the view point of a home-care doctor who assists patients with their final wishes to die at home, I summarize the issues involving the section of medical treatments, the extent and frequency of end-of-life pain, the methodology of pain palliation, and the facts of end-of-life care at home. I also present several clinical cases of end-of-life home care and discuss its demand and problems.