Ethan Krogman Cluster Course December 4, 2017

Capstone Case Study Analysis

Ethically, is it permissible for the Golden Years Retirement Community to instill a policy

of requiring genetic testing for Alzheimer’s disease in order to gain entrance into the

community? Ann and Carl Bradley have been planning retiring into this community for

numerous years, and undergo the APOE genetic test for acceptance into Golden Years. While

Ann’s test results come back as acceptable; Carl’s test results do not reflect the same outcome as

Ann. In the case of Ann and Carl Bradley, and their dismissal from Golden Years. I will argue

that the policy used by the Golden Years Retirement Community is not permissible by using the

ethical theory of prinicplism.

What is Alzheimer’s? Alzheimer’s disease is a degenerative brain disease in which the

build up of Amyloid plaques because of difficulty in processing a protein called, amyloid

precursor proteins (APP). When paired with the neurofibrillary tangles this causes the death of

neurons, thus bringing about the changes associated with Alzheimer’s disease. It can be

subsequently be traced back to a location on chromosome 19 where APOE has been associated

with Alzheimer’s. If someone has a predisposition to Alzheimer’s it can be estimated that this

gene can increase the risk by five to thirty percent. What does this do? In this case, it begins with

memory loss, and progressive dementia in the early stages. Then progressing into the later stages

where an individual would need total assistance for activities of daily living. Eventually, the

death of the individual is brought about by an external factor such as an infection of some sorts,

not the disease itself.

The ethical theory of prinicplism includes the principles of autonomy, beneficence,

nonmaleficence, and distributive justice will be taken into account when analyzing Golden
Ethan Krogman Cluster Course December 4, 2017

Year’s entrance policy. Autonomy, refers to direct one’s own life as they see fit based on an

informed, and reflective decision. Beneficence, is the duty to prevent harm, removing evil or

harm from a situation, or to promote well-being in an individual. Nonmaleficence is the duty to

refrain from actions that would cause harm, not imposing risks of harm on someone, and not

taking part in inflicting harm in general. Finally, distributive justice is the fairness of distribution

of burdens, resources, and benefits amongst a society or group of individuals.

Autonomy speaks for the interests of Carl, and Ann Bradley. When planning their

retirement together at Golden Years are aware of the policy of requiring a genetic test prior to

acceptance into the community by undergoing such testing. As both Carl, and Ann know the

results of these tests can have a dire, or beneficial result for their acceptance into Golden Years.

Thus, I believe both Carl and Ann were giving their consent as to the possible outcome of not

being allowed into Golden Years. If there were fears of such bad results from either Carl or

Ann’s test, they both could have autonomously chosen to retire at some other place outside of

Golden Years where possibly the genetic test requirement was not present. But this was not the

case as they both, a married couple, should be allowed to retire at Golden Years besides the fact

that Carl may or may not have the predisposition to Alzheimer’s.

For Carl’s sake and his admittance into Golden Years one has to understand the incidence

rate, and the effect that because someone with the APOE4 allele does or does not mean they will

develop Alzheimer’s. According to the U.S. population, it is estimated that approximately ten

percent of the population over sixty-five, and fifty percent of the population over eighty have

Alzheimer’s. It afflicts two million Americans annually killing one hundred thousand of those

individuals each year. Carl tested homozygous for the genetic loci (4/4) for Alzheimer’s, and

while this is a poor prognosis for Carl it does not necessarily mean that Carl will develop the
Ethan Krogman Cluster Course December 4, 2017

disease at all. Oppositely, just because Ann tested (3/2) on her prognosis does not mean she

cannot develop Alzheimer’s as well eluding to the fact that this disease is multifactorial.

Beneficence would argue that the policy used by Golden Years is unacceptable because

of the perspective of the retirement community itself. Golden Years states that by not allowing

individuals with the markers for the development of Alzheimer’s that it would keep costs low,

and maintain the positive atmosphere of the establishment. This seems to be problematic, as it

has been stated that Alzheimer’s is a multifactorial trait, and because one may have a good or

bad prognosis does not mean they will develop the disease at all. Going against that it would cost

Golden Years more money to care for these individuals, and not raise living costs. Ultimately, at

some point in time current residents of the Golden Years could develop Alzheimer’s as the result

of the late-onset form of the disease; then would these individuals be banned from the

community if they had already been living there for a certain period of time prior? Because of

the rejection of Carl and Ann from Golden Years, the establishment has not prevented the harm

of a strained marriage between Carl, and Ann, the severe depression as a result of the news of not

being allowed into Golden Years, and the possible societal ostracism from their friends that they

have told. By allowing Carl and Ann such outcomes presented would have not happened.

While there is no effective treatment for Alzheimer’s the current treatments including:

cholinesterase inhibitors boost the levels of the neurotransmitter, acetylcholine, in the brain

slowing the progression of the disease.

Nonmaleficence, would agree that the policy used by Golden Years is not acceptable as

well by the harm it causes on the Bradley family. When discovering the results of the test Carl

becomes severely depressed, thus adding another medical condition he would have to treat.

Secondly, finding the outcome of the test results adds to the possibility of social ostracism that
Ethan Krogman Cluster Course December 4, 2017

there could occur if friends would find out. Thirdly, it causes undo stress upon the marriage

between Carl, and Ann which could lead to a possible divorce. Leading Ann to go and retire at

Golden Years by herself, and leaving Carl behind. Fourth, it creates unneeded worry between

Carl, and Ann; as in Carl’s case there is the possibility that Carl may not even develop

Alzheimer’s at all. Finally, in the end it deprives these two with the chance to live at their dream

retirement facility, Golden Years, for the remainder of their days alive.

Distributive justice would argue that this policy as well would not be acceptable by

Golden Years to use. Because of the test each of the potential applicants are required to take, and

for an individual like Carl, this is an unfair distribution of care facilities to those who have poor

prognoses or the disease itself. It disadvantages these individuals to acquire the care they need

while others would be accepted because of their better prognoses. This also argues with the

statement that Golden Years states it would save money because of not having to care for

individuals with Alzheimer’s. As it was stated, because of the late onset nature of the disease it

can occur at any moment, and the costs would still be present if a resident of Golden Years

would happen to develop the disease.

The process in which prinicplism takes with this case would give precedence to

nonmaleficence as because of the test, and its results for Carl and Ann it causes unneeded harm,

and stress to these individuals when if they were allowed such things would not occur.

Nonmaleficence, to not do harm, refraining from actions that would cause harm, and not

imposing the risk of harm on someone. Overall, I stand by the statement that the policy in which

Golden Years Retirement Community requires genetic testing for Alzheimer’s disease is not

permissible.