Moral Challenge of Alzheimer Disease, Second Edition, The

The Moral Challenge of Alzheimer Disease, Second Edition

Stephen G. Post

The Johns Hopkins University Press, Baltimore, MD, 2000, 157 pp., $18.95 (paperback) or $39.95 (hardcover)

The turn of the millennium brings us to a new world filled with treatment and technologic advances that may provide hope for unlocking the secrets of many diseases and assistance in deciding which treatments are appropriate, futile, or burdensome. One disease that has followed us into the new century is Alzheimer disease (AD). Currently, four million Americans have AD. Many of these four million are still living at home, with a family member as their caregiver. In many cases, as the disease progresses the person with AD begins to require 24-hour care, seven days a week-at which time many caregivers seek longterm care as an appropriate alternative. Many challenges confront a person with AD, and many of these challenges will be shared by their caregiver, whether they be a family member, friend, or health care provider. Moral issues will become the greatest challenge, and informed decision making will be most critical. In the book "Ethical Issues from Diagnosing to Dying: The Moral Challenge of Alzheimer Disease," Stephen G. Post addresses the difficult challenges associated with the progression of AD from diagnosis to dying.

In the first two chapters, Post focuses on "the moral challenge of inclusivity and care for deeply forgetful persons and the family's role in meeting this challenge" (p. 44). The rest of the book focuses on very specific ethical dilemmas for which every patient, caregiver, and provider should be well advised. Post presents the following chapters, which present issues and concerns that confront people who are affected by AD: "The Fairhill Guidelines on Ethics" (with Peter J. Whitehouse), "Genetic Education," "Enhancing the Well-being of Persons with Dementia," "The Case against Artificial Nutrition and Hydration" (with Margaret C. Circirella), "An Argument against Assisted Suicide and Euthanasia in the Context of Progressive Dementia," and "A New Ethics of Dementia Care."

The book is written in such a way that the reader cannot help but become aware of the sincere compassion that Post feels toward people with dementia. The content challenges the reader to reflect on the moral issues and the significance of providing palliative care in combating the desire for assisted suicide. He stresses the importance of good palliative care practices in the treatment of AD and expresses his philosophy as "prevent, delay, or cure this disease, treat behavioral problems with appropriate psychiatric medications, and avoid pain and suffering, but do not make efforts to extended lives in the advanced state of this terminal illness" (p. 10).

Post states that he does not believe in assisted suicide, and because of the real life experiences he has had in listening to thousands of people dealing with AD, he brings to light compassionate alternatives and instills a sense of hope in those who have been diagnosed with AD. He states, "By giving people with dementia this hope for dignified care, we make the appeal of assisted suicide less powerful." (p. 126).

Post has provided a well-researched book with an outstanding bibliography that will be helpful to all caregivers as well as health care providers. The book is well organized, with each chapter dedicated to the various issues faced during the different stages of AD. This text provides information to guide readers before and during ethical and moral decision making and is very sensitive to the various emotions that one endures when the diagnosis is AD.

Sr. M. Peter Lillian DiMaria,

O. Carm

Director, Avila Institute of

Gerontology, Inc.

Carmelite Sisters for the

Aged and Infirm

Germantown, NY

Copyright Catholic Health Association of the United States Jul/Aug 2001
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