Some difficult decisions in ALS/MND

The physical and emotional damage caused by ALS creates ripples that reach a wide group of individuals beyond the patient. Decisions about care and end of life are never straightforward; solutions are always bespoke and must involve the wider multidisciplinary team. There is a need for awareness of how these discussions will be affected by personal attitudes, experience, culture and issues in our own professional and personal lives. The aim should be to respond to patient and family and be honest, sensitive, empathic, understandable and direct, with a constant balance of hope with realism. Finally, as professionals we have our own need for support and to be aware of our own feelings to prevent the very real threat of compassion fatigue (20). A strong multidisciplinary team is greater than the sum of its parts, and can provide robust internal support to its members, using their pooled expertise to serve patients and their families more effectively as a result.