Alzheimer’s’ disease blood tests are raising serious ethical dilemmas. Still in development, and not yet available to the general public, the blood panel tests identify lipids in the blood that indicate the presence of Alzheimer’s with a 90 percent accuracy rate. Although not yet available, the mere knowledge that the test exists raises serious ethical and moral dilemmas.
Alzheimer’s is a very expensive condition to treat, and even more expensive to manage. It is the sixth leading cause of death in the United States each year. More than five million people have been diagnosed with the ailment, and one out of three seniors dies from some form of dementia, including Alzheimer’s.
The costs of treating Alzheimer’s are astronomical and climbing rapidly. In 2013, the Alzheimer’s Association predicted that the U.S. would spend $203 billion for the treatment of Alzheimer’s. That does not include the 17.5 billion hours of unpaid care provided by family, friends, and nonprofit organizations, at an estimated value of $216 billion. By 2050, it is estimated that Alzheimer’s treatment will cost $1.2 trillion, as the costs increase to reflect the aging of the U.S. population.
If the tests prove as accurate as the preliminary results indicate, they might very well upset the entire health care system as we know it. One possible outcome from reliable and inexpensive Alzheimer’s testing may very well be the rationing of medical care. Another might very well be a further relaxation of the current restrictions on euthanasia, which could bring modern medicine into a head to head confrontation with both religious beliefs and traditional social values.
If used to test someone who is already showing preliminary symptoms of the disease, the blood test would provide confirmation of the medical findings, and suggest a course of treatment using the current best practices to forestall the development of the disease. For people who have family histories of Alzheimer’s, the blood tests could provide emotional relief for families suffering under the fear that the normal symptoms of aging – occasional forgetfulness, motor control issues, and changing physiology – are in fact precursors warning of the disease’s presence.
If the tests are positive, however, they could trigger serious life changes that may or may not be necessary at that stage in the disease process. They could also trigger denial of benefits from insurance companies, who could make Alzheimer’s tests a condition for enrollment in health insurance programs.
Under the Affordable Care Act, consumers cannot be denied health insurance on the basis of a pre-existing condition, but the Affordable Care Act is itself under intense scrutiny and may not survive a change in Washington, should Republicans gain control over both houses of Congress in the 2014 by-election, and the presidency in 2016. Under those circumstances, the Affordable Care Act would probably suffer its own termination, to be replaced with a Republican version of health care reform that might not have a clause barring discrimination on the basis of pre-existing conditions since that is one of the provisions in Obama care that the insurance industry hates most.
Another scenario that blood testing for Alzheimer’s can create is social upheaval affecting the entire family system. When someone is diagnosed with Alzheimer’s in their later years, after age 65, families have a tendency to rally around the victim, and Social Security and Medicare is there to absorb most of the costs of treating Alzheimer’s patients.
However, there is another scenario. If patients are diagnosed with Alzheimer’s early on, they may no find their families as supportive, since Social Security and Medicare will not be available to pick up the bills, and Medicaid would soon collapse under the burden of the disease. Couples about to marry might decide that Alzheimer’s blood test might be in order and might decide not to wed if one party or the other were to come back with a positive finding. Other couples might feel forced to divorce one another to protect the family’s assets from the cost of Alzheimer treatment.
Life insurance is another issue. Life insurance applicants may be asked to submit to an Alzheimer’s blood test as part of the application process to qualify for life insurance. If insurers get test results indicating a high likelihood that the applicant may come down with Alzheimer’s disease someday, even younger applicants for life insurance may be turned away on the grounds that the test only tests for lipids that indicate a high likelihood of contracting Alzheimer’s but it does not indicate when the applicant may come down with the disease. Given the astronomical care costs associated with the condition, the government may also require Alzheimer’s testing for everyone to determine the nation’s risk assessment for the continuing escalation of the expenses associated with the ailment.
Anyone who has ever known anyone who even thought they were coming down with Alzheimer’s knows how important an accurate test would be to allay those fears, or to help families plan for the eventual onset of the condition. While Alzheimer’s treatments have not advanced to the stage where detection could result in prophylactic measure to prevent the onset of the disease, the ability to predict who will get the disease, and who will not, will be a major step toward the improvement of treatment and the development of preventive measures. As it is now, it is extremely difficult to test preventive measures because researchers have to wait to see if a given patient will develop the disease at a future point and testing protocols on patients who do not have the condition, and never will, would be entirely fruitless.
With the Alzheimer’s Disease blood test raising ethical dilemmas, it remains true that being forewarned is forearmed. It may not make people facing Alzheimer’s any happier, but it will make them wiser and understanding that a loved ones strange behaviors are the result of a medical condition, and not the onset of normal senility, may help families to make the time they have less unpleasant for everyone.
By Alan M. Milner