Ethical issues in multiple sclerosis.

Multiple sclerosis is a chronic neurologic disease that follows a variable and uncertain course and has a profound effect on every aspect of the lives of patients and their families. Many ethical problems arise for patients, families, and caregivers. These include when and how to tell the patient the diagnosis, decisions about having children, various aspects of medical management and drug trials, concerns regarding quality of life, the effects and consequences of cognitive and psychologic impairment, and end-of-life issues. Ethical issues may also arise for the patient in relation to work and environment and to the impact of the disease on the family. This article is intended to prepare the physician who treats patients with multiple sclerosis to address these various problems.