The notion that science has little, if anything, to say on human values and ethical behaviour is challenged in a book by Harris (2010) where he argues that human knowledge and human values can no longer be kept apart and that – in principle at least – science can help determine what we ought to do if we are to live the best lives possible.
Given this context, how might the knowledge acquired from the scientific approach to treatments for Alzheimer's Disease (AD) influence the values that could shape the ethical landscape surrounding this issue? AD is the commonest cause of dementia in the UK, affecting around one in 14 people over the age of 65 years and one in six people over the age of 80 years (NHS, 2022). The need for effective preventive and therapeutic treatments for AD is acute but given the current lack of success in addressing it, Daly et al (2021) warn that some clinicians may be tempted into undertaking ethically questionable therapies. For example, ‘some clinicians engage in so-called “innovative practice” for AD patients without robust supporting evidence’, and by way of illustration Daly et al (2021) cite the popular metabolic enhancement for neurodegeneration (MEND) protocol, central to which are modalities like diet, supplementation, sleep, stress, and metabolic markers (eg heavy metals, oxidative stress, insulin, inflammation). MEND, say Daly et al (2021) ‘is based on papers published in 2014 and 2016 by Dale Bredesen and colleagues in the journal Aging’ and Daly et al (2021) further claim that the evidence favouring such interventions is overstated in the scientific and lay press, with weak data and uncertainty about conclusions ignored.
A further ethical aspect concerning the treatment of AD is raised by Gustavsson et al (2021) who note the promising intensive research being undertaken on drug candidates that reduce amyloid ß in the brain. Their main point is that it is ethically suspect to select eligible candidates for treatment unless robustly effective treatment is available since ‘… these drugs target people at risk for AD, who must be identified before they have any, or only moderate, symptoms associated with the disease’, requiring a screening strategy (Gustavsson et al, 2021). But as screening is undertaken at a societal level, not an individual one, there is a degree of pressure for individuals to undergo testing, which could increase the risks of unnecessary anxiety and overtreatment compared with regular healthcare.
Responding to Gustavsson et al (2021), Eriksdotter (2021) observes that the most important question ‘is how to define efficacy and how great the health benefits need to be to justify ethical costs. This is really easier said than done in a disease with a progressive decline.’ And Richard (2021) points out the risk of over medicalisation, suggesting that ‘the potential harms of screening for AD should not be ignored … In short, there is no evidence base for any form of screening for AD whether in a preclinical stage (an entity that in itself is disputed) or (early) symptomatic stage’ (Richard, 2021).
Perspective develops over time, so it is interesting to consider a review by Savulescu (1997) of a book published by Stephen G Post in 1995 on the moral challenges raised by AD. According to Savulescu, Post demurs from the assumption that dementia equates with a lower quality and value of life and he criticises ‘the “hypercognitive” culture that places “excessively rationalistic” criteria for inclusion in the moral community’, favouring instead ‘unconditional equality’ that is ‘based on the “incomparable human worth that everyone has as a human being”’ (Savulescu, 1997). Perhaps anticipating the increasing probability of AD screening and genetic testing, Post warns against ‘rule by “genocrats” and moral problems in aborting foetuses found to be at risk of developing AD’ (Savulescu, 1997).
The need for effective preventive and therapeutic measures against AD is undeniable, but perhaps those who concentrate on a purely scientific approach to meeting this need might usefully consider the possibility that there are attendant ethical issues worthy of reflection. As Harris (2010) makes clear, the idea that there should be a separation between human knowledge and human values is one that is open to debate. However, as is often the case, ethical issues are only addressed in the wake of scientific advances.