Result card

  • ETH9: Does the implementation or use of IGG affect the user’s moral, religious or cultural integrity?
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Does the implementation or use of IGG affect the user’s moral, religious or cultural integrity?

Authors: Plamen Dimitrov, Anelia Koteva

Internal reviewers: Pseudo99 Pseudo99

Despite the common belief that the principles of bioethics are universal and applicable to every culture and society and that have always existed in the religious and moral traditions in various forms, the possibility that some of them may collide with one another at a certain stage of development and/or treatment of AD patients cannot be completely excluded.

 

Major religions (Christianity, Judaism, Islam and Buddhism) do not differ significantly in terms of their generally positive attitude towards human, with slight variations about prioritizing human body or soul, which might result in minor discrepancies in their opinion as to what extent a person should be allowed to self-decide on issues such as the maintenance or termination of life (for example, the application of euthanasia in AD’s terminal stage). With the mild cognitive impairment phase, however, this dilemma is out of the question, whereas the above-mentioned religions show a positive attitude with respect to all possible methods of treatment of the human body and soul.

 

Despite the principally expressed considerations, the concrete therapeutic technology under discussion might raise objections among some religious groups in light of the application of whatever therapy, i.e. some religious movements reject medical treatment, while others (such as “Jehovah’s Witnesses”) oppose blood transfusion practices. Therefore, there is a risk that the use of blood products in the form of immunoglobulins may be met with resistance from the supporters of the above-mentioned religious movement[1].

 

Ethical rules and virtues are likely to come into conflict with the moral of a particular social group. The enrollment of AD subjects or persons with MCI in a clinical trial group to be treated with immunoglobulins presumes these subjects to have already been diagnosed, which would mean that the above individuals are labelled as “mad” or “incurably ill”. This could negatively impact on the individuals and their families, relatives and friends in their future social contacts. Cultural differences linked to the use of information and decision-making in patients suffering from “formidable diseases” may further complicate the situation. In the USA, it is accepted among some groups such as Mexican Americans, Korean Americans and Navajo to inform family members about the health of their significant other before telling the diagnosis to the sick person himself/herself. In Ireland, 83% of the relatives of people suffering from dementia are against the disclosure of the diagnosis to the patients themselves, considering that learning/knowing it may harm the sick person causing him/her anxiety, stress, despair and depression. In this aspect, a conflict may be expected regarding the autonomy of the patient (i.e. his/her autonomy in the treatment decision-making process may be reduced). Therefore, autonomy of an individual depends largely on the people around him/her, their affiliation to a particular social group or community and cultural values, as well[2].

 

As another prerequisite for a potential conflict between the administered therapy and the pursued social policies in some countries could be mentioned the disparities in the burden between the costs of caring for patients suffering from Alzheimer’s disease and the social costs linked to other public health diseases. In recent years, Alzheimer’s disease has been recognized as a key public health issue because of its significant morbidity, high cost of related care and lack of effective definitive treatment. AD patients, due to their advanced age, are likely to have comorbid chronic diseases, such as diabetes, coronary problems, congestive heart failure and others, making it hard and expensive to treat.

 

[1] See: Alvargonzález, D. “Alzheimer’s Disease and the Conflict between Ethics, Morality and Politics”, Journal of Alzheimer’s Disease & Parkinsonism, March 2013, available at: http://www.omicsonline.org/alzheimers-disease-and-the-conflict-between-ethics-morality-and-politics-2161-0460.S10-004.pdf ; “Personhood”, Alzheimer Europe, January 2013, available at: http://www.alzheimer-europe.org/Ethics/Definitions-and-approaches/Other-ethical-principles/Personhood ; “Ethical Issues in Practice”, Alzheimer Europe, October 2009, available at: http://www.alzheimer-europe.org/Ethics/Ethical-issues-in-practice .

[2] Ibid.

Dimitrov P, Koteva A Result Card ETH9 In: Dimitrov P, Koteva A Ethical analysis In: Jefferson T, Cerbo M, Vicari N [eds.]. Use of Intravenous immunoglobulins for Alzeheimer’s disease including Mild Cognitive Impairment [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 30 October 2020]. Available from: http://corehta.info/ViewCover.aspx?id=267