An F&M professor and his former student – now a doctor – teamed up to explore an ethical puzzle: What if a patient's current best interests conflict with their past living will directives?

Dr. Ben Lin, a 2017 Franklin & Marshall graduate, and Associate Professor of Philosophy David Merli are unraveling the complexities of dementia and advanced directives.

Merli describes the research as "a little medicine, a little philosophy."

A patient's advance directives – often in the form as a living will – can decline medical care for their future incompetent self.

What Merli and Lin found, however, went against conventional thought. A subset of patients who recovered from a rare brain disorder mimicking Alzheimer's retrospectively endorsed the continuity of their values throughout their period of dementia (Alzheimer's is the most common cause of dementia).

Merli and Lin's core claim is that the loss of competence does not entail the absence of values, caring, or exercise of the will that commands respect in treatment decisions.

"To the Brink and Back"

Lin discovered a subset of patients who had been previously demented to the point of incompetence due to Normal Pressure Hydrocephalus, a disease caused by an abnormal buildup of cerebrospinal fluid in the brain's cavities. The condition can mimic the symptoms of Parkinson's and Alzheimer's – primarily, a dementia-like state.

"Normal Pressure Hydrocephalus is one of the few diseases where it's possible to interview someone who has been to the brink and back – someone who has had the experience of losing all their faculties and is able to tell you about it with all their faculties intact," said Lin, now a doctor at Harvard Affiliated Emergency Medicine Residency at Mass General Brigham.

Lin briefly read about the condition during his first year of medical school at University of South Florida Morsani College of Medicine; it resurfaced when he was instructed to choose a medical school project.

From Mentorship to Partnership

Lin's interest in medical ethics traces back to Merli's mentorship at F&M.

"I had absolutely no interest in philosophy," Lin said. That quickly changed after taking several of Merli's classes.

"I found the philosophy of moral ethics to be really fascinating. I figured I'd try to write a philosophy paper of my own around medical ethics," said Lin, who majored in biochemistry and molecular biology at F&M.

Now, their bylines appear together in "Dementia, Valuing and Advance Directives," published in April 2020 by Wolters Kluwer Health Inc. on behalf of the American Academy of Neurology.

In addition, Lin presented the research at the American Academy of Neurology's 2020 conference while in medical school. It's rare for the academy to feature students – highlighting just how novel this research is.

"When I was in undergrad, I found the philosophy of moral ethics to be really fascinating. I figured I'd try to write a philosophy paper of my own around medical ethics."

– Dr. Benjamin Lin '17