Clinical and Ethical Perspectives
Michael Gordon, MD, MSc, FRCPC
Vice President of Medical Services,
Baycrest Centre for Geriatric Care,
Professor of Medicine,
University of Toronto,
Toronto, ON.
David Goldstein, PhD
Director, Centre for Knowledge Transfer,
Baycrest Centre for Geriatric Care,
Professor of Psychology,
University of Toronto,
Toronto, ON.
The daughter told me (MG) that Dr. L. was prescribing Donepezil to her 87-year-old mother. "Do you agree with her decision?" she queried, then added, "We won't use the "A" word will we?" This recent exchange reflects the anxiety and fear that accompanies the communication of a diagnosis of Alzheimer's disease. It presents many complex clinical, legal and ethical problems, which may be challenging to many physicians.
Physicians are generally expected to communicate honestly and directly with their patients on matters of clinical significance. For patients suffering from Alzheimer's and other dementias, such straightforward communication may not always be appropriate. The patient may not be aware of his or her own cognitive changes and family members may balk at the idea of communicating such a devastating diagnosis. The physician may be left with a clinical and ethical conundrum: the desire to communicate honestly with the patient may conflict with the compelling desire to concur with the wishes of the patient's family.
