Does Early Diagnosis of Alzheimer's Really Create an Ethical Dilemma?

Contributed by: Dennis Fortier, President, Medical Care Corporation

Does early diagnosis of Alzheimer's really create an ethical dilemma?

For all of the press devoted to scrutinizing the pros and cons of delivering an Alzheimer's diagnosis to a patient with only mild symptoms, including a front page article in today's NY Times, it is easy to overlook the question posed above. In fact, anyone could be forgiven if they assumed, based on the constant characterization in the press, that a dilemma is at hand.

The Dilemma That Isn't

Posing this question may generate provocative headlines and robust debate but, if we step back and consider the larger context, there really is no dilemma. We do not need any ethicists to ponder and rule on this question because it doesn't require a single, universal answer.

Some people seek clinical information and get comfort from having it available, even when the information consists of bad news like an Alzheimer's diagnosis. Others prefer ignorance when new information will cause them to worry needlessly about a situation they cannot change.

Patients Choose
Rather than debating which approach is better and pronouncing the presence of a dilemma, all we need to do is let individuals choose their preference. Those who want to know should be told; those who do not want to know, needn't have the information thrust upon them. When someone has a sign or symptom of a medical problem and then seeks a physician's opinion about the underlying problem, they are pretty much declaring that they want a diagnosis. In the real world, the "want-to-know vs. don't-want-to-know" decision is made by either consulting a physician or not.

This situation is not as black and white as described here, but it certainly is far less gray than characterized by the press. In general, people seeking medical attention for a cognitive complaint want help and physicians have an obligation to diagnose the problem and treat it as effectively as possible.

Sometimes this will involve giving patients news they would rather not hear, but the symptoms and the angst that comes with those symptoms, are already a reality in the patient's lives. A definitive diagnosis reduces uncertainty and helps the treatment process move optimally forward.

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