Ethical Issues of Caring for Dementia Patients in Nursing

Ethical Issues of Caring for Dementia Patients in Nursing

Introduction

With the increasing number of dementia patients, nursing professionals continue to face more ethical dilemmas in providing healthcare to dementia patients. Among other many areas, obtaining the informed consent of dementia patients on the medical intervention to use is a significant concern. Dementia patients at the late stages of illness are usually incapacitated and are unable to communicate. Substitutive decision-making is adopted for these patients by using expert directives or surrogates. As such, the autonomy of the patients in making decisions is disregarded. Although the patient is cognitively incapacitated, his interest may not match those of surrogates. An ethical issue, therefore, exists between autonomy of patient in decision-making and choice of appropriate treatment intervention, given the patient is cognitively incapacitated. A combination of articles on the subject has been compiled, exploring the subject o in-depth, identifying the ethical challenges, and providing insights to nurses on how to address the moral issue.

Article 1- Involvement of dementia patients in care planning and decision-making

Donnelly, S., Begley, E., & O’Brien, M. (2019). How are people with dementia involved in care planning and decision-making? An Irish social work perspective. Dementia, 18(7-8), 2985-3003. Retrieved from: https://journals.sagepub.com/doi/abs/10.1177/1471301218763180

This article is a qualitative research study on the involvement of dementia patients in decision making and the care-planning process in Ireland. The circumstances leading to the study is the application of both national and international policies on dementia patient’s decision-making in their healthcare planning process and the adoption of a rights-based approach to this patient’s decision-making process. The ethical issue is the involvement of dementia patients in making decisions about their healthcare process and whether they should be granted that right in health and social care services. The study adopted a cross-sectional research design among the older people, 39% of whom were dementia patients, and utilized social care programs.

The study concluded that dementia patients were not involved in making decisions about their healthcare planning. The reasons pointed for lack of involvement of dementia patients in decision-making include lack of capacity to do so, the patient’s family member’s preferences, difficulties in communication, consumption of time, and complete denial of the chance to participate. The findings were substantiated through interviews that were conducted on health and social workers. The study observes the significance of involving patients in decisions regarding their healthcare planning process. The article also points out the specific challenges faced by healthcare professionals in involving dementia patients in decisions concerning their healthcare planning. Recommendations are also present on how to participate in dementia patients in healthcare planning.

The article is useful since it identifies that dementia patients are under-involved in decision-making concerning their healthcare planning. It gives the challenges and ways that healthcare professionals can improve the participation of these patients in the decision-making and healthcare planning process. It will be used to show how the ethical issue of dementia patients’ involvement can be handle within the healthcare profession. This source is a credible resource since it is published on sage, which is an accredited journal publisher. Physicians and re-known medical professionals also author it.

Article 2-Supported decision-making for dementia patients

Sinclair, C., Gersbach, K., Hogan, M., Blake, M., Bucks, R., Auret, K., … & Agar, M. (2019). “A Real Bucket of Worms”: Views of People Living with Dementia and Family Members on Supported Decision-Making. Journal of Bioethical Inquiry, 16(4), 587-608. Retrieved from: https://link.springer.com/article/10.1007/s11673-019-09945-x

This article is a peer-reviewed research study on the level of application of supported decision-making for dementia patients and the opinions of both dementia patients and their family members on the practice. The qualitative research adopted the Interpretative Phenomenological Study Analysis research design. Supported decision-making is one of the policy-based approaches for ensuring the participation of dementia patients in decision-making concerning their healthcare provision. The study focused on identifying the level of involvement and the period for which dementia patients were involved in supported decision-making. Also, the study focused on safeguarding decision-making, the various supported decision-making arrangements that were in place, and the challenges on decision-making. The research observed that dementia patients trusted family members on supported decision-making. The constraints that affected the range of choices available to a patient’s decision-making included financial, cultural beliefs and the degree of freedom to choose. The study found that supported decision-making provided a framework for involving dementia patients in decision-making. However, the study reported a conflict resulted between patients and family members as a result of the transition in decision-making with progressing dementia stages.

The article is useful since it describes the different views of both dementia patients and their families on supported decision-making. Nurses must understand supported decision-making as a way of providing for dementia patients to participate in decision-making. Nurses should also understand how the patients and their family members feel about the approach, as well as constraints of supported decision-making. The source will be used to indicate that supported decision-making, as a way of addressing an ethical challenge in the nursing profession which draws mixed reactions from dementia patients and their families. The given recommendations will give insights on how nurses can properly use supported decision-making as a way of involving dementia patients in decision-making. The limitation is that the research is audience-specific, and therefore, interpretation is needed for general application.

Article 3-Ethical Issues in dementia patients: Choosing treatment intervention

Whitehouse, P. J. (2000). Ethical issues in dementia. Dialogues in clinical neuroscience, 2(2), 162. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181593/

This article is an exploration of different ethical issues that arise in healthcare professionals regarding dementia patients. Among the many ethical issues that the article identifies, the informed consent process is of significant interest in this paper. It gives opinions and views caring for dementia patients and the ethical issues that arise in different stages of the disease. The ethical issues are segmented into the early stages of the disease, middle, and end-stages. During the late stages, the patient is incapacitated and unable to make any communication. As such, the ethical issue of informed consent regarding the use of restraints on the patient becomes a significant challenge to healthcare givers. Nurses are faced with the moral problem of what treatment intervention to use for the patients in this stage, given that the patient is unable to communicate or give consent. The opinions are substantiated and supported with references from credible sources. The article identifies future trends in ethics around the provision of healthcare to dementia patients.

This source will be used to illustrate that the choice of the most appropriate treatment intervention method presents key ethical challenges to nursing professionals, especially at the later stages of dementia. It will also be used to show the specific ethical issues regarding nursing dementia patients at each stage of the disease. It is peer-reviewed with views from several credible authors, therefore, enhancing article credibility. The future of ethics in dementia healthcare provision will be integrated into the paper to indicate how caring for dementia patients will affect the nursing profession.

Article 4- autonomy in decision-making for people with dementia

Wright, M. S. (2019). Dementia, Healthcare Decision Making, and Disability Law. The Journal of Law, Medicine & Ethics, 47(4_suppl), 25-33. https://journals.sagepub.com/doi/abs/10.1177/1073110519898040

This article is a systematic review of literature on the independence of dementia patients in making decisions regarding their treatment. The author of the article states that many dementia patients are not given a chance to make decisions regarding their treatment planning owing to the patients’ lack of the capacity to make decisions. As such, the writer of the article qualitatively reviews literature supporting the idea that dementia patients should be allowed to autonomously make decisions about their treatment irrespective of their cognitive incapacities. The article points out that appropriate models should be formulated to reduce the need for substitutive decision-making until the last stages of the disease. The legal aspect of higher directives and the surrogate’s involvement in making decisions for dementia patients has been a debated issue for long due to the ethical issues of patient’s interests and that of proxies. The author proposes that autonomy can be provided by prioritizing the patient’s current interest in making decisions at the late stage of the disease. The article also explores the law concerning the autonomy of decision-making by people with disabilities.

This article is a credible source given its publication in the JOURNAL OF LAW, MEDICINE, AND ETHICS by the Sage publications. The author of the article is a professor of medical ethics, which makes this a professional piece of work. The arguments are supported with enough credible reference works. This source will provide evidence that autonomy in decision-making for people with dementia is an ethical issue. It will also provide the legal framework providing for autonomy in decision-making by dementia patients. The context of the research is suitable for this research. However, the scope is too broad, and interpretation is needed to narrow down to specifics on the background of ethical issues concerning caring for dementia patients in the nursing profession.