Bioethics post #1

Dilemma: Dr. Sandra Selleck was conducting a research study on the effects of an Alzheimer’s drug called THA, which has the potential to slow the progression of Alzheimer’s disease. In search of participants in her study, Dr. Selleck reached out to a large regional nursing home St. Mary’s. She knew the sample would include many patients eligible for her study and wanted the opportunity to visit the home to interview patients for the study. Dr. Selleck discussed the inclusion criteria of the study with St. Mary’s director Ann Wilson, which included patient consent, consent from the patient’s closest relative, and no objections from the care staff at St. Mary’s. Dr. Selleck stressed the importance of competency of the patients in terms of enrollment in her study. After hearing this proposal, Ann decided she didn’t want any of the individuals at St. Mary’s to be enrolled in the study. She felt as though the study was exploiting elderly people and treating the patients as guinea pigs. Dr. Selleck was surprised at this response since her study had been reviewed by many ethics boards and was given considerable endorsement. Was Ann right to turn down Dr. Selleck’s request? Is Dr. Selleck’s study exploiting a vulnerable elderly population?

Discussion: I think there are many important questions at play here. For one I think the concept of patient autonomy and competency in Alzheimer’s populations is a difficult situation. Alzheimer’s disease is a progressive disease that causes a decline in memory and other mental faculties. A patient is not always lucid and therefore can’t always be deemed mentally competent. This makes it difficult to decide whether a patient has autonomy in something such as a medical trial. This then brings into effect the importance of the patient’s closest relative, clinical staff at St. Mary’s, and any doctors that may be treating the patient. Alzheimer’s populations are especially vulnerable groups but should they be given the chance to participate in a potentially lifesaving trial? How can their competency be judged? I believe to a degree that enrolling elderly Alzheimer’s patients in a clinical trial based on competency has some level of exploitation but this must be weighed with the notion of ‘do no harm’. If there is a potential drug on the market that could help a patient live for a couple more years or save the lives of future victims, then the line blurs a bit. The question is whether Ann is protecting the patients or keeping them from a lifesaving drug. This also brings up the question of whether this decision is rightfully Ann’s to make for the entire population of St. Mary’s. A decision such as this should be made by the patients at the home, the close relatives to those patients, as well as the doctors closely involved in the cases of these patients. As much as competency can be questioned, it is still the patients and their governing body’s decision about whether to participate in a situation such as this. The patients have a right to be informed on the study and then make the decision for themselves about whether to participate. These patients deserve a voice and Ann is taking that away from them. A balance has to be reached between respecting patient autonomy and nonmaleficence. These individuals deserve a discussion in their own treatment while at the same time having a governing body that is accounting for the vulnerability of Alzheimer’s patients. This brings into question whether Ann is really protecting them by not allowing them to participate in this study.

Works Cited:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford University Press, 2001.
Mayo Clinic Staff Print. “Alzheimer’s disease.” Overview – Alzheimer’s disease – Mayo Clinic. N.p., 22 Dec. 2015. Web. 21 Jan. 2017.

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: Case Studies in Biomedical Ethics. Ontario: Broadview Press, 1987.