by Lawrence H. Phillips II, M.D.
Recognizing that respiratory failure and/or inability to take in adequate nutrition is frequently the cause of death in cases of ALS, I hereby wish to state in advance my preference regarding invasive mechanical ventilation and feeding gastrostomy tube placement. It is my desire that these preferences guide the decision making of my family and my physician(s) in the event that I am unable to participate in a meaningful way in discussions regarding my health care. I understand that none of the choices made here will be put into effect without my
agreement as long as I retain the capacity for decision making and the ability to communicate, in some form, those decisions.
I. With regard to invasive mechanical ventilation requiring endotracheal intubation, it is my preference that:
(Choose one of the following three main options):
If invasive mechanical ventilation is used and it becomes evident that long-term mechanical ventilation is required, then (choose none, one, or more of the following):
II. With regard to nutrition provided by feeding percutaneous gastrostomy tube (PEG), it is my preference that:
(Choose one of the following two main options):
In all cases where I choose not to start or to discontinue mechanical ventilation or nutrition via gastrostomy tube, I instruct my physician to provide me with adequate medication to relieve anxiety and discomfort that may occur during the final course of my disease.
(Used with permission of the Journal of Clinical Neuromuscular Disease. 3(3):116-121, March 2002)