Caring for seniors in long term care can be challenging at times. Providing 24/7 care to individuals with dementia, on the other hand, can be more ethically and morally demanding. The incapacity to make one’s own decisions and choices, to act in one’s own best interests, and to clearly verbalize one’s own wishes create many ethical dilemmas and issues for both caregivers and families. Attempting to balance a person’s safety, for instance, with their need for independence and freedom is one of these dilemmas. Where is that fine line between the two? Deciding what is in a person’s best interests should be done by whom? Making decisions about daily care, treatments, and quality of life isn’t to be taken lightly. These decisions are ethically and morally complex.
Abundance of Ethical Issues
Ethical dilemmas are to be found everywhere in senior care, especially for residents living with some kind of dementing illness, like Alzheimer’s disease. If we are to believe in the principle of autonomy or that of self-determination, exactly how do they apply to the care of someone with dementia? If a life-threatening condition arises, can the individual refuse treatment altogether in an effort to die sooner? Is a decision like this still their right to make? What about personal or romantic relationships that blossom in long term care? Can one be considered a consenting adult with dementia? Does the right of privacy apply?
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Of course, there are other more common ethical problems in the care of seniors with dementia residing in long term care. Making one’s own choices on a daily basis is one such issue. Choosing what to wear, what to eat, and where to lounge can create some interesting “problems” for staff. What if they choose clothes that don’t match or are considered “inappropriate”? What if they wish to lay on the couch in the front of the building where visitors come and go? Is this considered inappropriate? Whose quality of life are we talking about? Visitors and employees, or the resident?
Then add family dynamics into the mix. Behavioral challenges. Decisions about medical care. The problems of abuse, neglect, mistreatment, or exploitation. What about the use, or over-use, of psychiatric medications? Respecting choice, and protecting autonomy, capacity, and competence are important for anyone, but for those with dementia, they become even more important. Eventually the individual will die. What ethical problems will arise then?
What Are Best Interests?
One day, someone will be making decisions for us based upon our “best interests”. What exactly are best interests and how do we know what they are now, and in the future? What if we cannot speak and communicate our best interests? We would try our best to take into account the individual’s past and present wishes and their feelings and emotions, and come up with something considered to be their best interests. This can become very muddy, as you can see. What can be of great help when making these decisions are advance directives and living wills. Having a power of attorney or a guardian can be helpful as well. Still, making decisions for an individual who is very confused and can no longer communicate is a big ethical challenge.
Final Thoughts on Ethics in Dementia Care
I didn’t mean to make this short article so philosophically heavy, but apparently that’s where my mind took me – and now you. If you work in senior care long enough, you will notice ethical questions all around you, morning, noon and night. Dementia and I are old friends. My grandfather had it and was placed in a nursing home when I was 10. My mother passed away with dementia a couple years ago. Now, we believe one of my older sisters may have some kind of dementia. I often wonder who will make decisions for me, should I develop dementia in the future. I think about how employees will treat me. I would want to be as independent as possible and make my own decisions, about both life and death. I would like to have some say over treatments and medications. I would also like to believe that whoever is making decisions for me will make them in my best interests. But, will they?
(NOTE: Interested in learning more about Ethics in health care or Dementia care? Checkout my Ethics CEUs and Memory Care and Dementia CEUs on CEU Academy and try a FREE CEU today!)