Ethical Aspects of Dementia Care

Ruth Landau

in Social Work

ISBN: 9780195389678
Published online June 2012 | | DOI:
Ethical Aspects of Dementia Care

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Dementia is a clinical concept characterized by a person’s progressive decline in mental functioning, eventually leading to loss of identity and total incapacity. The medical profession identifies the following common dementia illnesses: Alzheimer’s disease (AD), vascular dementia (VaD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD). AD is the most common form of dementia. Although AD is usually associated with aging, it is also found in younger persons. With deteriorating memory, judgment, and ability to communicate, the person with dementia becomes increasingly more dependent upon others. This continuous decline leads to the need for greater involvement of family members, who provide the majority of the care. Care for persons with dementia raises many ethical dilemmas for caregivers, both family members and professionals, particularly when aggressive behavior, restlessness, wandering, and eating problems are involved. Issues of decision making, formal and informal assessments of capacity, and respect for the personhood of persons with dementia are central in this respect. The need to decide whether the value of autonomy or the value of safety of the person with dementia should be favored can be a burden for caregivers. The potential of paternalism, or dementia care that is dominated by the caregivers’ needs for control over the behavior of persons with dementia, may be another issue of concern. The primacy of autonomy-based values in guiding decision-making processes was challenged in the late 20th and early 21st centuries and replaced by the ethics of care, focusing on a more relational approach, one that views human relationships as central to care. Social work, focusing on the interface among the individual, the family, and the environment, has a unique role in guiding persons with dementia and their families through the process of this devastating disease. Scholars such as Cox (Cox 2007, cited under General Overviews) and Sanders and Swails (Sanders and Swails 2011, cited under Professional Caregivers) argue that social workers can and should assume a more central role in the decision-making process relating to dementia care. Advance statements, preferred priorities of care, lasting power of attorney, or choice of a proxy can be discussed, and decisions can be made together with the person with dementia and the family caregivers while the person still has the capacity to make decisions for the future. Social workers’ skills in assessing the needs of people with dementia and those of their families may also help other professionals and lead to the development of more family-friendly policies.

Article.  9678 words. 

Subjects: Social Work

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