You diagnose a patient as being in the early stages ofAlzheimer’s. The patient is a sixty-one-year-old male, a professorof music, very active both as a teacher and a performer, with highvisibility in the community. He has a wife, who is an architect,and two children, both in their thirties with successful careersout of state. The patient is shocked by the diagnosis, but is notcompletely surprised; he had been forgetful lately, as well asbecoming disoriented while playing familiar pieces and havingincreasing difficulty learning new ones. He is vain about hisabilities and very much in control of all he does. His loss ofcontrol disturbs him, and as he gets over his shock he becomesdetermined to fight the disease. You are able to arrange for him tobe tested for a new research project involving a proposed treatmentto slow down the progress of Alzheimer’s when it is detected earlyenough. When the tests come back (the entire process has takenabout three months), your diagnosis is confirmed but your patientis denied participation in the research project because(unexpectedly) the disease is too advanced. This disappointmentcoupled with increasing incidences of disorientation whileperforming music (there has been little substantial eff ect on hisday-to-day functioning) has deeply discouraged your patient. Twoweeks later, your patient returns and asks you to provide him withenough medication so that when he decides that the disease hastaken too much of him he can die. He says he has thought deeply andhard about this. He does not want to end up a burden to his familyand friends. He is a skilled teacher and does not want to end upunable even to communicate with others. But most of all he does notwant to live without his ability to perform and enjoy his music. Asa physician, what do you do?
