I got to have another great conversation with Dr. Jeff Ratliff for the Neurology journal podcast. When he had me on last time to talk about dementia ethics more generally, I wasn’t able to talk yet about the position statement that our committee has been preparing to address the many challenges raised in decision-making regarding this controversal new drug. In this discussion we considered how to counsel patients and families given the drug’s lack of established benefit, known harms, potential negative effects on the entire Medicare system, and health equity concerns given the exclusion of Black, Indigneous and Hispanic patients from pivotal clinical trials. At the end, Dr. Ratliff asked a tough question about a scenario in which a patient really desires treatment; I did my best to illustrate how frameworks of shared decision-making may be helpful in such situations.