The interests of patients should come first, but when it is dubious that continued treatment is in a patient’s interests and there is no way to find out what the patients wants, or would have wanted, it is reasonable to consider other factors, including the views of the family and the cost to the community. Medicare costs for beneficiaries with Alzheimer’s disease were $91 billion in 2005, and are expected to increase to $160 billion by 2010.