[Comment] End-of-life decision making in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis is a disease of inexorable decline, with death due to respiratory failure occurring 3–5 years after onset of the first symptom. The disease is rare in early life but increases in frequency at ages 60–80 years, and decreases thereafter.1 Although physician-assisted suicide remains illegal in most countries, it is legal with strict guidelines in the Netherlands, Austria, Belgium, Canada, Germany, Luxembourg, New Zealand, Spain, Switzerland, and parts of the USA.2 The methods by which, and reasons why, people with amyotrophic lateral sclerosis seek to end their lives are likely to be affected by factors that include cultural and religious influences, which have not been extensively studied to date.