Negotiating ethics in dementia care

Providing care for people with dementia is often complex and ethically difficult, and is guided by the values of people with dementia and professional and lay carers. Each participant brings often different, and sometimes conflicting, perspectives, which contribute to the difficulty of negotiating suitable care. This research examined how participation and inclusion were facilitated by community psychiatric nurses and social workers to achieve care for people with dementia. Practice was observed to provide snapshots of interactions between people with dementia, practitioners and lay carers, and interviews with practitioners interrogated practice. The analytical framework used was Tronto's (1993) ‘integrity of care’, taken from the wider feminist political argument of an ethic of care (Gilligan, 1982). The adoption in practice of an ethic of care strengthens the opportunity for increased participation and inclusion and therefore aims to provide care that fits with the values and preferences of people with dementia and their carers. The research found that of 50 people with dementia, 10 were placed in permanent placements such as nursing homes and residential homes, some unwillingly. This article discusses what happens in care when the ethical elements of an ethic of care are practised, and when they are not.