Anna Gerlich

12/5/16
Capstone Case Study Analysis
Should the Golden Years Retirement Community be allowed to turn away
applications for admission if they are tested positive for Apolipoprotein E (APOE)
test? Tests that indicate that an individual with two copies of one form (allele e4) of
the gene have a higher risk (5-30 times higher) of developing Alzheimers disease
later in life. This moral question is arisen after Ann and Carl Bradley of Pines Bluff
are refused admittance into the retirement home because Carl was tested positive
and had a poor prognosis (4/4) alleles. By using the ethical theory of principlism, it
is possible to reach a conclusion to this moral question.
The ethical theory most related to this topic is principlism. Principlism
includes 4 individual principles that assist in reaching an ethical decision. The first
principle is beneficence. Beneficence involves the duty to act in ways that help
people promote their welfare. This includes preventing harm, removing harm, and
promoting good. The second principle is non-maleficence. This is described as a
duty to act in ways that do not cause harm to people. Non-maleficence is refraining
from doing things that cause harm. The third principle involved in principlism is
autonomy. Autonomy is the right to direct the course of ones own life. This includes
a persons right to hold views, make choices, and take actions based on personal
values and beliefs. According to autonomy, no one else should be able to make a
decision for someone else with the person having no say in it. Finally, the last
principle is distributive justice. This involves the fairness of the distribution of
benefits, burdens, and resources. Justice looks to make sure that no one person or
group of people are receiving more benefits or burdens compared to another person
or group of people. In order to fully apply principlism, one needs to decide which
principles are relevant. Once they determine which are relevant, an analysis under
each relevant principle must be done. If there are conflicts among different
principles, a person much decide which principle takes precedence over the others.
Concerning the case at hand, the first relevant principle is beneficence. In
applying beneficence, it is observed why the retirement home chose to develop
these standards in the first place. Their rationale was because patients with
Alzheimers disease negatively affect the retirement community. They cost the
home more in terms of nursing care fees and have an overall demoralizing effect on
the general atmosphere, which in result, discourages new entrants. This policy is
seen as a way to promote the general welfare of the rest of the people in the
retirement community. If someone has Alzheimers disease, they are more likely to
cause harm to other people in the community. People who suffer from Alzheimers
disease need total assistance to live in the later stages of the disease. This
increases costs of nursing care and overall attention from staff members.
The next relevant principle is non-maleficence. This involves the chance of
receiving a false negative from the test. In other words, this means that someone
may test positive for the extra allele, e4, but still not get Alzheimers later in life, or
even not have the extra allele, and do get the disease. It is held true that one third
of all Alzheimers patients are e4 negative. So this brings into question whether or
not Carl will develop the disease in the first place. There is a sixty six percent
chance that Carl himself will not even develop Alzheimers. Then looking on the
other side, there is a chance that thirty three percent of people who are accepted
into the home will develop Alzheimers. In terms of non-maleficence, are they really
imposing risks that harm other people? In fact, they are going against their original
claim by not being able to see past the test. Odds are, they will not be able to get
around not having any Alzheimers residents. So why not let those in who have a
slightly higher risk of developing the disease?
Also relating to non-maleficence is the idea that this situation has put a lot of
emotional strain on Ann and Carl. Carl has become severely depressed and there
are increased tensions in their marriage. There is also the embarrassment that
comes from them not getting accepted into the home. Ann and Carl are ashamed
and realize their friends and family will know why they did not go through with their
long awaited plans. By not enacting this policy, the retirement community could
have refrained from these actions that caused harm to Ann and Carl. In result, the
policy breaks the rules of non-maleficence.
The third relevant principle is distributive justice. Ann and Carl are being
deprived of the services that they need in their later stages of life. How is this a fair
policy for people and couples like Ann and Carl? Denying access into the retirement
is not following distributive justices terms of a distribution of resources. Ann and
Carl are not the only ones who will be affected. In reality, 10% of people over 65
and 50% of people over the age of 80 will develop Alzheimers. This shows that
there is a large part of the population who are being neglected and not receiving
fair treatment by this retirement home. It is not an uncommon disease.
The final principle related to this situation is autonomy. Autonomy is relevant
in that each side is allowed to direct their own life. The retirement community home
has autonomy in that other facilities have a right to choose their admittance
standards as well. Managers should be allowed how they want their business to run.
Looking at it from the other side, however, Ann and Carl also have the autonomy to
choose what retirement home they want to spend their later years in. The home
shouldnt be allowed to decide this for them. So after analyzing autonomy, these
two facts just cancel each other out. It is hard to determine whose autonomy is
more important.
In conclusion, after analyzing the situation with the ethical theory of
principlism it can be concluded that the retirement homes policy of neglecting
admittance when a person is found to have two copies of the e4 allele, is not
ethical. The principle of beneficence does not hold its grounds compared to the idea
of non-maleficence and autonomy. Non-maleficence and autonomy clearly hold
more ground and show a greater precedence in the situation.