Result card

  • ETH12 / SOC5: Are there factors that could prevent a group or persons to participate?
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Are there factors that could prevent a group or persons to participate?

Authors: Plamen Dimitrov, Anelia Koteva, Alessandra Lo Scalzo, Cristina Mototolea, Ingrid Wilbacher

Internal reviewers: Pseudo99 Pseudo99, Pseudo253 Pseudo253, Pseudo340 Pseudo340

Acknowledgments: ,

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).

 

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 resisted against by the supporters of the above-mentioned religious movement.

 

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”, thus leading to depersonalization and other negative consequences for the individuals and their families, relatives and friends in their future social contacts. 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.

 

In support of the above is the huge financial, ethical and social burden on the patient’s family and relatives, who, also, consider it moral and ethical to participate in the treatment process options as much as this choice affects their quality of life. Alzheimer’s disease is becoming a key public health issue because of its significant morbidity and duration, high cost of related care and lack of effective definitive therapy. AD patients, given their advanced age, are likely to have additional comorbid chronic conditions such as diabetes and cardiovascular diseases, making treatment harder and more expensive. The choice of therapy should furthermore take into account a number of other factors, such as age, place of residence, social status, ethnicity, culture, health budgets, insurance coverage, opportunities for peripheral venous access, allergy or renal disease, all of which not only make treatment costly but may limit IVIG administration due to expected complications.

 

In terms of healthcare, the costs of caring for AD patients exceed the social costs, which is also a prerequisite for a conflict between the applied therapy and the social policies in some states.

Dimitrov P et al. Result Card ETH12 / SOC5 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 31 October 2020]. Available from: http://corehta.info/ViewCover.aspx?id=267