Dementia Patient Ethical Dilemma

Mrs. M is a 60-year-old who was diagnosed with early onset dementia and has been experiencing brief moments of memory loss. She has been living with her daughter L. L has been jobless since she completed her undergraduate studies one year ago. Mrs. M does not have any other children. Recently, L got a new job in another state. She is due for relocation in a month’s time. To a large extent, L has been instrumental in efforts to promote the health and wellbeing of Mrs. M. In L’s opinion, as well as per a recent assessment, Mrs. M would require placement in a care home following L’s relocation. However, Mrs. M is against this suggestion. She maintains that she is capable of taking care of herself.

In basic terms, an ethical dilemma could be conceptualized as a scenario whereby one has to make a choice between two (or more) decisions – in which case all the available decisions result in the compromise of a certain moral or ethical principle. More specifically, in the words of Lachman (2009), this could be described as “a situation in which a difficult choice has to be made between two courses of action, either of which entails transgressing a moral principle” (p. 79).

In this ethical dilemma a decision must be made to either:

1. Honor Mrs. M’s desire to live alone and compromise her safety OR

2. Place Mrs. M in a care home against her will and violate her autonomy.

Action 1: Honor Mrs. M’s desire to live alone and compromise her safety

Outcome: Honor and advance Mrs. M’s autonomy

Although safety happens to be an important consideration for all persons, it is especially instrumental for dementia patients. To a large extent, safety in this case has got to do with the prevention of injury. There are a number of presenting symptoms that specifically make dementia patients more prone to certain safety concerns. These are inclusive of disorientation, memory loss, as well as confusion.

Advantages: In this case, Mrs. M will have her independence and live in a familiar environment. This would in turn promote her comfort (i.e. in relation to the various home luxuries) and make it possible for her to lead a more independent lifestyle. One way of increasing or promoting patient independence, as Bombard et al. (2018) point out is via patient engagement. The said engagement involves not only the consideration, but also the implementation of patient perspectives. As a matter of fact, according to the authors, “patient engagement has become a cornerstone of care and is frequently a stated goal for healthcare organizations” (Bombard et al., 2018, p. 99). It therefore follows that in granting Mrs. M her wishes, a deliberate move would have been made to grand this particular user of healthcare services her rightful role in the overall care equation.

Disadvantages: There is a clear risk of harm in allowing Mrs. M to live by herself. According to Brooker and Lillyman (2013), persons diagnosed with dementia happen to be at an increased risk of fall. Further, anxiety alongside forgetfulness could, according to the authors, make it risky for a person with dementia to be left unattended to for long periods of time. Zolkefli (2017) argues that in some instances, choice (in the advancement of patient autonomy) is not always a good thing in the healthcare context. In the words of the author, in seeking to ensure that patients are involved in decision making and their choices respected, “one has to remember that, choice comes with a cost, and it is a colossal one; that offering everybody a greater degree of control over what they receive will create winners and losers” (Zolkefli, 2017, p. 95). In the present context, Mrs. M’s long term wellbeing could be hurt by granting her wishes. Further, it would be prudent to note that this course of action would cost the family a significant amount of money which would have been spent in making modifications to Mrs. M’s house so as to make it safer for her to live alone. The said modifications could have been inclusive of the installation of CCTV so that her family can monitor her from time to time, the installation of chairlifts, railings, ramps, etc.

THIS CAN BE USED AS PART OF THE ANALYSIS/IT IS PART OF THE PAPER

In so doing, we could cite the need for us to prevent harm. To a large extent, this would be in line with the ethical principle of non-maleficence. As per this principle, it is presumed that professionals working in the healthcare realm have a mandate or at least a responsibility to ensure that a patient is protected from any harm (Frezza, 2018).

Action 2: Place Mrs. M into a care home against her will

Outcome: Violating Mrs. M’s autonomy

ANALYSIS for action/outcome above:

In this case, we would have violated Mrs. M’s autonomy by placing her in a care home against her will. In basic terms, patient autonomy has got to do with “the right of patients to make decisions about their medical care without their health care provider trying to influence the decision” (Wilkinson, Savulescu, and Hope, 2008, p. 211). Thus, in choosing this course of action, we would be violating Mrs. M’s desire to live alone as she desires without any attempt to challenge her decision.

Advantages: ADD INFO RELATING TO PATIENT AUTONOMY

In addition, this course of action would mean that Mrs. M does not live alone – effectively reducing the risk of harm associated with living alone.

Disadvantages:

The move could trigger other psychological issues such as depression on the part of Mrs. M. Mrs. M might also end up being unable to adapt to the care home environment due to the loss of independence and home comfort that she so dearly treasures. Further, it would involve the violation of one of the most important principles in medical ethics, i.e. patient autonomy. According to Ubel, Scherr and Fagerlin (2018), from an ethical standpoint, patients ought to be granted an opportunity to make their own decisions about the interventions proposed. As per this perspective, no attempt should be made to exert undue influence upon patient preferences.