As we enter the 21st century, growth of the elderly population, the costs of care, and the advances of medical science and technology will continue to have an impact on the patient-physician relationship. Transformation of the health care system will also raise ethical issues inherent to changing roles. The special nature of Alzheimer's patients and the natural course of their disease requires special care on the part of physicians to meet the ethical challenges and establish medical goals, in conjunction with their patients and their families, which are consistent with reasoned, compassionate care.