5.0 out of 5 stars
Ethics behind Alzheimer Disease patients, October 19, 2010
This review is from: The Moral Challenge of Alzheimer Disease: Ethical Issues from Diagnosis to Dying (Paperback)
With medical revolution sweeping over the world, human lifespan was elongated. As aging society continues a demographic transition toward 85 and older, number of elderly people suffering from chronic dementia drastically increased. The Alzheimer's Disease topic which is the most prevalent type of dementia became the hot issue. While most books in library shelves which focus more on fact, history, molecular biology, and possible treatment of AD, The Moral Challenge of Alzheimer Disease provides another aspect of Alzheimer's disease. Throughout the book Stephen Post's book focuses more on the bioethics of the care for Alzheimer's patients.
Most people fear Alzheimer's disease probably more than cancer. According to author, the reason is that person with AD will eventually outlive much of his or her brain meanwhile "the person with cancer will retain his or her autobiography, or life story, and the sense of temporal continuity between the past, present, and the future". Are the patients only the one suffer from the disease? The caregivers may also have to struggle for watching their beloved ones suffering and caring for the one who cannot even remember his or her family member.
Due to Post's numerous experience of dementia patients, he uses autobiographical narratives based on his experience. For those who want answers on the moral basis of caregiving by spouses and children of Alzheimer's Disease patients, Chapter 4 may help them to find an answer. It requires constant attention and patients to care for AD patients who have behavioral and mental difficulties.
My favorite chapter is chapter 7 entitled "Quality of Life, Treatment Burdens, and the Right to Comfort." The chapter focuses on the ongoing debate on the ethics of the quality of life versus the ethics of the sanctity of life. Alzheimer Diseased patients cannot make a decision, so family member should be one to make a decision to provide medical treatments for the patient. Should the families or physicians be provide invasive medical care for a patients whose conscious is unclear?. Post argues that invasive medical treatment may deteriorate patients' quality of life. In chapter 2, AD patients should not be interpreted as half empty rather than as half full. Although AD patients usually do not have self-awareness or self-control, they still deserve lives deserved for human being. He used the severe word such as "inhumane life-extending treatment" in order to support his claim. He believes that "Families, physicians, and society should carefully consider patients best interest". In order to contradict the argument that AD patients do not have quality of life, he used the example from the pet-facilitated programs in nursing homes. Researches have proved that pets foster sociability, enhance morale, reduce reliance on psychotropic medication, and provide significant forms of sensory stimulation." Because it is proven that people with dementia can have an enhanced quality of life, Stephen argues that families should respect their lives. Although Steven made his argument open-ended in order to avoid severe opposition, I was very impressed his opinion.
However, I disagree. I, a faithful Christian, believe that people's lives are provided by god. Because people owe lives to god, we should preserve natural life until god calls it back. Therefore, I believe that human lives are sanctified and families do have responsibility to provide best medical treatments regardless of patient's intention. In addition, as Alzheimer Disease patients are medically dead and unhopeful, I believe that being alive means something. Despite a patients have to suffer from painful treatment, the fact that he can breathe and still seeing his family for one more second is gracious gift not only to patient himself but to families. Life is so valuable that nothing can replace it, and even some amount of pains from treatment can be endured. Therefore, I think it is ethical for AD patients to have best medical services.
The most interesting section of the book is the seven-step program called FOCUSED to identify the major elements for the maintenance of communication with Alzheimer Disease Patients. F stands for Face to Face. We should face the AD patients directly to attract his attention. O stands for "Orient": We should orient the person by repeating key words several times". It will give patients time to comprehend what we said. C stands for Continuity: We should continue the same topic of conversation for as long as possible. U stands for unsticking: We should help the patient become "unstuck" when he or she uses a word incorrectly by suggesting the correct or missing word. S stands for Structure: We should structure our questions to give the patient a choice of response. E stands for Exchange: We should keep up the normal "exchange" of ideas we find in conversation. Lastly D stands for Direct: We should keep sentences short, simple, and direct. Communication is a very important step to fight off dementia. However, communicating with dementia patient is a very hard step. However, the acronym FOCUS provides steps for communication in an efficient way that is very easy to memorize.
I think every caregivers who has AD patients in their family will find this book to be helpful. Treating them is not an easy task, and requires patience. However, the book rationalize caregivers for their ethical behaviors, and also provide instructions that will help them to cooperate with patients. Also, doctors who treat AD diseased patients as a brain-damaged-comma-like person should read the book and have a second thought on the their patients.
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