Ethical Dilemma: Who Should Test For Alzheimer's?

Contributed by: Dennis Fortier, President, Medical Care Corporation

Is this really a dilemma?

Researchers have devised what seems to be a highly accurate test to identify the signature proteins of Alzheimer's disease in spinal fluid. In a publication about the test in this month's Archives of Neurology, the test showed perfect accuracy in patients known to have Alzheimer's disease.

One particular application of this technology could have great clinical utility. When aging patients present to their physician with memory loss, the physician must consider many possible causes of the problem before prescribing treatment. In some instances, the physician can find an obvious culprit such as stroke, depression, or a number of metabolic conditions. In other instances, the diagnosis is less clear. This new test might add much needed clarity to the diagnostic process for identifying Alzheimer's disease. This will help get AD patients on proper treatment in a timely manner while preventing others, who might otherwise be misdiagnosed with AD, from receiving wrong treatment.

Some more difficult questions about the value of this new test have arisen from the fact that, in the study, the test showed that about one third of subjects who had no symptoms of memory loss, also had the signature proteins in their spinal fluid. One interpretation is that these subjects have early stage pathology and will eventually develop the symptoms. This has given rise to the dilemma: Who should get tested and what should we do with those who test positive?

I would argue that this question, which is framed in terms of the entire population, poses no dilemma at all if you frame it at the individual level. Those who wish to inform themselves about risks in their future, so as to prepare themselves legally, financially, and spiritually, as well as to engage in life style modifications that could prolong health, should be free to have a test and learn what they can. Those who prefer not to know should be allowed that option as well. There are compelling arguments on either side.

As our understanding of the disease and our ability to treat it improve, the "find out early" side of the argument will be generally adopted by the masses and no debate will remain. In the meantime, there is no need to persuade everyone to accept one approach or the other. Those who prefer information should have access to it, while those who prefer ignorance should be allowed their bliss.

In a well-written summary of the ethical questions surrounding this science, bio-ethicist Jonathan D. Moreno commented on this development in The New Republic.
A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

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