The Moral Challenge of Alzheimer Disease: Ethical Issues from Diagnosis to Dying (review)

The Moral Challenge of Alzheimer Disease: Ethical Issues from Diagnosis to Dying, 2d ed. By Stephen G. Post. Baltimore: Johns Hopkins Univ. Press, 2000. Pp. ix +162. $29.95.

The stated goal of Stephen Post's solid examination of Alzheimer's disease is to provide carefully considered practical guidance to the increasing numbers of unfortunate people among us who are affected by dementia, either as sufferers or as caregivers to those whose cognitive abilities have slipped away. Post understands the priorities of his task and makes them known without hesitation and without apology. He writes in his preface: "I believe that ethics, to be meaningful, must begin with public service to an identified constituency. In the process of service, one learns about real-life experiences, one becomes an advocate, and, eventually, scholarship will flow. Grounded in service to and presence with the neediest, such scholarship proves practical."

Post, who is a professor at the Center for Biomedical Ethics of the Case Western Reserve University School of Medicine, adheres completely to that selfless vision of scholarship at its most pragmatic in The Moral Challenge of Alzheimer Disease. The book's many virtues originate in the simple fact that Post focuses attentively on the very populations he wants to address both as his subjects and as his audience. Post makes it his primary job in researching, organizing, and writing this work to assume a near-transparency for himself, as he gives full voice and a dominant presence to Alzheimer's patients and, even more importantly, to their caregivers. By constructing the book in this way, Post not only brings the reader into the poignant immediacy of life with dementia and with the demented, but he is also able to build a sound case for any solutions to be found for the many problems posed by the progressive loss of cognition. Simultaneously, and with subtlety as well, Post crafts his scholarly subtext, a stern moral condemnation of misapplied, unwanted, or intrusive technologies in an era when the life of the body can be prolonged more readily than the life of the mind can be assured.

Indeed, Post's moral thesis flows gracefully from his thorough understanding of that modern existential predicament. Science and technology have afforded the means for a long life span for the majority of people in our society, yet in the process of such a transformation of what we take for granted as normal longevity, our technical capabilities have enabled more and more individuals to live long enough to become vulnerable to the erosion of their mental capacity. As a concomitant, society's onetime reverence for the wisdom of the elderly has been replaced by a tacit marginalization of the infirm and the weak of mind. Meanwhile, in a kind of ironic self-congratulatory haze, technology is in love with itself while the young and the robust revel in every new technological advance, as well as in their own position at the pinnacle of physical and mental mastery over their world. Sadly, however, there are built-in limits to all that.

Coping with those limits is the major subject that Post deals with. The second and third chapters of The Moral Challenge of Alzheimer Disease form the heart of the book, as Post first offers a comprehensive picture of the Alzheimer's patient, the caregiver, and the caregiving relationship, and then presents the Fairhill Guidelines, a series of well-founded pragmatic recommendations that emerged from a community dialogue in the mid-1990s sponsored jointly by Case's Center for Biomedical Ethics, the University Alzheimer Center, and the Cleveland Chapter of the Alzheimer's Association. Only someone as attuned to the complexities of life with dementia as Post is--and as dedicated to the Alzheimer's community of both patients and caregivers--can so gently, straightforwardly, and on occasion so humorously portray the Alzheimer's...