Slowing the progression of Alzheimer disease: ethical issues

Abstract

Slowing the progression of Alzheimer disease (AD) can be regarded as an unambiguous benefit only up to a point. Beyond that point, the greater human good will involve letting the downward progression proceed. However, defining this point is not easy. It may be useful to distinguish the then-self, i.e., the intact self that relates past, present, and future, from the now-self, i.e., a state in which the demented individual recognizes only the present. In decisions involving treatment and the prolongation of life, many believe that the (precedently expressed wishes of the) then-self takes precedence. Decisions about slowing disease progression involve not only the then-self but the medical community and the caregivers. They, too, may agree that slowing the progression of AD beyond a critical point is unacceptable.