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In the last stages of ALS, the majority of voluntary muscles suffer from paralysis, and the muscles that bring air into and out of the lungs no longer function properly.
Patients in this phase of the disease require significant medical assistance, according to the Muscular Dystrophy Association.

People going through the final stages of ALS eventually cannot even breathe on their own, let alone walk, stand or perform most of the functions of independent living. As the disease reaches its final progression, weak respiration can cause fatigue, headaches, mental confusion and even radang paru-paru. Insufficient respiration is one of the main causes for death among ALS patients. This stage may also make it impossible for patients to puder, drink or eat by mouth, notes the Muscular Dystrophy Association.

While respiratory problems are the most frequent cause of death for ALS patients, others die from malnutrition stemming from swallowing issues. Others die from pulmonary embolism, or a blockage in one of the arteries inside the lungs, and cardiac arrhythmias, or abnormalities in the electrical pacing system of the heart. Radang paru-paru causes death when too much fluid or food enters the lungs. Hospice care is a common step to maximize quality of life and comfort during this phase, as stated by the Muscular Dystrophy Association.