This is a case concerning the ethical considerations of research on a particular group of people. It is worth noting that there will almost always be someone objecting to any sort of research on some contrived arguments, however this case merits valid consideration. The group on question is the elderly, which is defined by the World Health Organization as those persons over 60. (http://www.who.int/healthinfo/survey/ageingdefnolder/en/) The more specific group is the elderly afflicted with Alzheimer’s and cognitive dementia. The question arises from a request to gather subjects in a drug trial from a nursing home. The director of the nursing home stalwartly refused all participation in the study over ethical concerns of exploitation. While her arguments contain some logical they are misguided. In the discussion of the case there are multiple issues raised, the first being the institutionalization of these patients and they effects that causes. Primarily there is a sense of dependence on the institution or a sense of debt. An institute for the elderly will also likely have the inevitable effect of lowering the self-worth of the occupant. This is likewise connected to the lack of a sense of purpose or contribution to society in the elderly. All of these could be considered coercive factors to provide consent for the study when they otherwise would not, which is the argument of the director.  Coercion is clearly an ethical wrongdoing, particularly in what is meant to be an impartial study as it hinders autonomy. However the determination as to whether there is an element of coercion in consent to the study is up to interpretation. The review boards of several hospitals found no problem in the sampling procedures. There is consideration made to the fact that the mental competence of these patients, but that problem is solved by the need for consent in triplicate from the patient if possible, the closest relative and the caretakers. The director seems to be acting out of an irrational paternalism towards her patients in an overprotective manner.  There is a suggested dualism in the elderly and the juvenile. The juvenile are certainly given a special set of rules. Some seem to believe that the elderly deserve a special classification in the same way, just at the other end of their life. The reason juveniles are treated differently is due to incomplete maturation, which is not something that is in play for the elderly.  With each piece of the argument in the consideration I come to the conclusion that the director was in the wrong to deny her patients the opportunity to participate in the study.  Given the common feeling of lack of contribution in the elderly, the best remedy is an opportunity to contribute. The consequences of the study would be limited compared to the gain provided by the psychological relief. This is regardless of the potential benefit provided by the study if the study is effective.  The progression of the Alzheimer’s could be slowed providing great personal benefit and benefit to other afflicted with the disease. There is little to no corruption of autonomy truly present as participation is voluntary and consent is validated by the addition of the consent of the family member.  In addition if there was it could be justifiably balanced by the potential to medically improve the conditions of these patients. This trial is not an example of maleficence towards the patients but rather beneficence.

Jake Johnson