Ethical Issues in the Care of People with Dementia
Anamarija Oljacic 104566372
01-01-204 Fall 2018
November 20th, 2018
Bioethical Analysis of the Topic:
Roger Watson in his journal Practical Ethical Issues Related to the Care of Elderly People with Dementia says the care of elderly people with dementia raises its own ethical issues. Nurses are central figures in the decisions which are made about this group of patients and as such should ensure that the best interests of the individual patients are at the hearts of the decision-making process (Watson, 1994, p.152). The underlying ethical issue in the care of elderly people that Watson mentions is the loss of autonomy, which accompanies the declining cognitive abilities of the patient (p.152). This paper will start off with the subject of autonomy as starting points for care of people with dementia.
Autonomy is derived from the Greek, it means ‘governance of self’ (p.152). Autonomy in practical terms means that people have the right to make their own decision that should not interfere adversely with others, even if, by such their decisions, they constitute a risk to themselves (p.152). In nursing terms autonomy means that individuals should be respected and their human rights be upheld. There are several ways nurses are supposed to uphold this which is ensuring that people are not treated against their will and that they are informed about the treatment they get and that they are involved in the decision making of that care (p.152).
When a patient is diagnoses with dementia their ability to participate in any decision-making process for their care and treatment is lost. This also includes their ability to give consent to treatment or research because their ability to understand information is gone (p.152). With all of this to consider it then means that an elderly person with dementia who has completely lost the fundamental human attribute of remembering and being able to retain information are, consequently and permanently, no longer autonomous (p.153).
Someone who is autonomous can give consent to medical treatment and indeed to nursing care, but the principle of autonomy from the ethical point of view, is precisely the same whether medical treatment or nursing care is being considered (p.153). The legal position regarding medical treatment is that it cannot be applied to a person but those who for children or people detained under mental health legislation –without the specific consent of the person the treatment is being administered to (p.153). However, an elderly person with dementia especially in advanced stages are incapable of giving consent by virtue because they are incapable of understanding the treatment they need. It is then necessary to have what Watson explains either an implied consent of express consent. Implied consent is the sufficient for medical interventions which poses a minimal risk to a patient (p.153). A kind of example would be if a patient needed to be administered antibiotics from suffering of pain the nurse gives the patient it because it is necessary for the safety and comfort of the patient where it will cause minimal risk to them (p.153). Express consent would be if someone needed a procedure that carries risk and the patient expresses the express consent to have it, the problem is that this type of consent is impossible to administer to a patient with dementia (p.153).
There are ways where this problem can override is a legal procedure called consent by tutor dative, this involves the appointment of a person who, in legal capacity may take medical decisions on behalf of a mentally incapacitated person like someone with dementia. This kind of legal action is said to be expensive and therefore is not available for everyone, another aspect is that it involves the court and becomes complicated (p.154).
Another ethical issue that affects the care of people with dementia is the issues of beneficence. Beneficence means doing good and serving the best interest of a person (Jones, 2001 p.249). Doing good with serving the best interest of a patient means to maintain or improve the quality of life where there is some quality to be maintained (p.249). Not only that, disability and dependency is usually a crucial determination in the quality of life. This leads to the limited ability to choose, to control and manipulate one’s own life suggest less quality (p.249). Dementia can be considerable and not meeting the means of suffering and reduced quality of life but it is harder in older people with dementia to identify and analyse these needs (p.249).