Patients, caregivers, doctors, and healthcare organizations face particular difficulties as a result of Alzheimer’s disease. It is noteworthy that the deontological theory of ethics states that all clinical decisions must be made with respect to guidelines and what is right, regardless of the consequences. Still, there are issues, such as the issue of autonomy, where a medical professional might put restraints on a patient’s freedom, which will be in their best interest. Thus, honoring patient autonomy while recognizing their decision-making abilities that are gradually deteriorating and maintaining the provision of quality care in compliance with fundamental ethical standards are necessary while caring for people with dementia.
Ethical Issue: Deontology
The study of ethics, or ethical philosophy, entails organizing, justifying, and endorsing ideas of what constitutes appropriate and inappropriate conduct. The deontological theory basically promotes the fair treatment of patients and requires all medical professionals to comply with the rules, despite the outcome. According to this theory, whatever the outcome or any other considerations, the morality of a decision is exclusively determined by the form of the activity (Swartz, 2021). The decisions should, therefore, be made on the basis of what is most beneficial to the patient (Swartz, 2021). Without taking into account contextual factors, deontology regards behaviors as either good or bad. In these circumstances, one can think of the commandments from the Holy Scripture, which teach people not to kill, steal, or disrespect their parents (Swartz, 2021). It can be said that, similarly to commandments, Deontological principles separate right actions from wrong actions.
When speaking of the ethical issue of autonomy and restraints, it is vital to recognize how Deontology emphasizes respect and support of autonomy when it is the right decision to make. In this situation, when providing care for patients, limiting them in some kind of activities might be seen as a violation of their freedom and autonomy. However, if this is in the best interest of the patient and can prevent them from being harmed, it can be considered the appropriate choice in terms of Deontological logic.
Ethics of Dementia Care in Elderly Patients within Scholarly Literature
Dementia affects those in their elderly years, and the ones who frequently have additional co-morbid conditions and behaviors linked to dementia may be more dangerous. Following the issues of restricting freedom and controlling risk are those related to the application of both physical and pharmaceutical constraints. The physical constraint may take many different forms, ranging from the application of physical force to seemingly innocent activities like barring doors or placing a chair too low for the individual to get up from (Chien et al., 2022). In this case, a restriction in whatever manner must be roughly proportional to any possible damage to the individual. Obviously, there must be a compelling cause to apply constraint, and the methods employed should be based on the inadequacies of less invasive ones (Okuno et al., 2021). Healthcare providers can think it is ideal for a patient to remain at a hospital or clinic. It is a loss of liberty when a patient is unable to leave but is always under professional care and observation (Parker, 2020). Still, it must be demonstrated that this is appropriate and in the patient’s best interests before it may be authorized.
In the end, it is noteworthy that healthcare practitioners should keep in mind that risk is an unavoidable aspect of life and that decreasing risk in one domain might raise damage in another while doing this balancing exercise. Considering that autonomy and welfare both depend on freedom, risk management should carefully consider all potential hazards and benefits when evaluating the various elements (Parker, 2020). Therefore, decisions regarding autonomy require much consideration and still rely on the patient’s best interests.
Caring for Elderly Patients with Dementia: Guidance from RNAO
The Registered Nurses Association of Ontario (RNAO) emphasizes all practices and guidelines in their documents regarding proper patient care. RNAO (2018) provided and discussed guidelines for nurses providing care for patients living with dementia. The guidelines outline the responsibilities and roles of nurses in response to patient autonomy, privacy, and the provision of person-centered care. According to RNAO (2018), families of people living with dementia are direct partners that should be involved when providing care to people living with dementia. Registered Nurses are encouraged to provide continuous education and emotional support to families to cope with the emotional distress that accompanies the disease. During the education process, nurses are discouraged from influencing the patients or forcing them patients to choose to make decisions about the patient’s life.
RNAO is also an ardent supporter of person-centered care in caring for elderly patients with dementia. According to RNAO (2018), Registered nurses are encouraged to use evidence-based practices when treating and managing patients with dementia. RNs ought to create therapeutic relationships with patients and families, health promotion through creating awareness, and patient advocacy in the allocation of resources for better living standards (Lundberg, 2018). RNs are expected to be culturally sensitive and provide care to all patients regardless of age, gender, or social status.
The Media Coverage of the Autonomy Issue
Ethical issues in healthcare are often discussed in the media, focusing on the presumed negligence of medical personnel. For instance, Waterloo News discussed the practices of medical personnel when treating patients with dementia in one of the Canadian hospitals. The article emphasized how one study found that older hospital patients are more likely than their younger counterparts to receive restrictive treatments such as acute control drugs and medication in non-emergency scenarios (Waterloo News, 2022). Between 2005 and 2018, it was identified that there was a distinct trend of greater frequencies of these interventions being used in older persons in Ontario mental facilities (Waterloo News, 2022). In order to find out how frequently older hospital patients are constrained in non-emergency circumstances when compared to younger age brackets, researchers looked at 226,119 Ontario inpatient files over the course of these years (Waterloo News, 2022). Finally, it was accentuated that such control treatments have a number of detrimental health and psychological effects, especially in physically fragile older persons.
Obviously, in the given situation, the ethical issue of autonomy in decision-making is emphasized. Both scholarly and media materials emphasize that older patients with functional disabilities, aggressive behavior, mental retardation, and disorientation should receive treatment in accordance with their best interests. However, according to the media, before turning to such practices, person-centered and non-pharmacological management options should be considered (Waterloo News, 2022). However, the difference between scholarly material from the claim in the media is that medical personnel should make decisions in the best interest of the patients and the people surrounding them. Therefore, especially when aligned with scholarly material, such could pose a threat not only to themselves but others as well.
Social Justice and Patient Autonomy in Elderly People with Dementia
Whitehouse (2022) defined social justice as an approach that ensures that people living with dementia have access to resources and treatment that guarantee a life of dignity, regardless of one’s status. Social justice is all about ensuring equality and fairness in the distribution of resources and access to services. In a fair and just society, elderly patients diagnosed with dementia are allowed access to quality care regardless of social status, race, ethnic background, or gender. All people are allowed access to treatment and medications required to manage the symptoms of the condition, whether they are able to pay for the services or not. There is also a need for inclusive communities where individuals with dementia can lead comfortable lives without discrimination or stigmatization. Social justice can be attained through advocacy, where communities and physicians advocate for better programs and allocation of resources to cater for the unique needs of people that will develop dementia in the future to avoid straining the available resources.
Ethical Evidence-Based Actions for RNs to Promote Social Justice
Controversies surrounding caring for elderly patients can be addressed by Registered Nurses to promote social justice. When viewed from the perspective of social justice, care for elderly patients with dementia attracts ethical concerns that can be addressed by RNs. Bosisio and Barazzetti (2020) discussed the need for RNs to promote social justice through cultural sensitivity, bearing in mind that patients suffering from dementia can come from different races, ethnic backgrounds, and social classes. In addressing social justice, RNs are encouraged to address issues of discrimination, marginalization, and isolation of patients with dementia. Social justice can be pursued through fair and equal distribution of resources for the people in need. RNs can step in and train or educate families and caregivers on strategies that can be beneficial when living with elderly people with dementia. RNs can also advocate for the fair distribution of resources to meet the unique needs of affected individuals in society.
Conclusion
Dementia is increasingly becoming a healthcare concern in Canada and around the globe. The fact that more than a million Canadians are at risk of developing dementia calls for early preparation in tackling the impending problem. The condition impairs a person’s capacity to make independent and informed decisions, leading to a loss of autonomy. Loss of autonomy is an ethical concern due to the fact that every person has a right to freedom and the right to life. When other people, such as family members and physicians, make decisions on behalf of the patient, there are high chances of infringing on the patient’s rights, privacy, and freedom. RNs can advocate for patient autonomy by creating awareness, empowering families and communities, and providing psychosocial support to people living with dementia and their families. RNs should also be culturally sensitive and prepared to provide person-centered care to different populations of people suffering from dementia.
References
Bosisio, F., & Barazzetti, G. (2020). Advanced care planning: Promoting autonomy in caring for people with dementia. The American Journal of Bioethics, 20(8), 93-95. Web.
Chien, C. F., Huang, L. C., Chang, Y. P., Lin, C. F., Hsu, C. C., & Yang, Y. H. (2022). What factors contribute to the need for physical restraint in institutionalized residents in Taiwan?Plos One, 17(11), e0276058. Web.
Lundberg, K. (2018). Dementia care work situated between professional and regulatory codes of ethics. Ethics and Social Welfare, 12(2), 133-146. Web.
Okuno, T., Itoshima, H., Shin, J. H., Morishita, T., Kunisawa, S., & Imanaka, Y. (2021). Physical restraint of dementia patients in acute care hospitals during the COVID-19 pandemic: A cohort analysis in Japan. PloS One, 16(11), e0260446. Web.
Parker, J. (2020). Ethical issues in the care of people with dementia. InnovAiT, 13(6), 374-381. Web.
RNAO. (2018). Delirium, dementia, and depression in older adults: Assessment and care. Registered Nurses Association of Ontario. Web.
Swartz, M. H. (2020). Textbook of physical diagnosis: History and examination. Elsevier Health Sciences.
Waterloo News. (2022). Study finds excess use of non-emergency restraint among older psychiatric patients. University of Waterloo. Web.
Whitehouse, P. J. (2022). Ethical issues in dementia. Dialogues in Clinical Neuroscience. Web.