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Building an ethical infrastructure – a message to organisations

2015: Ethical dilemmas faced by professionals providing dementia care in care homes and hospitals

Caring for people with dementia in an ethical manner is not an option but a fundamental component of good care. This document was developed to provide guidance and training for health and social care professionals in nursing homes and hospitals faced with ethically sensitive situations and dilemmas in their work with people with dementia. However, as mentioned in the introduction, achieving ethical care and learning how to deal with such situations takes place in a particular working environment, which is affected by a range of factors such as staffing levels, skills and training, collaboration with colleagues, the hierarchical structure, budgets, laws and organisational procedures.

Despite these constraints, which determine to some extent the range of options available to individuals and teams, we emphasise the need for each health and social care professional to accept personal responsibility for ethical care and to address ethical dilemmas and challenging situations when encountered. To achieve this, they must be able to count on the support of their organisation. Ethical care must be a priority for those responsible for running the care homes and hospitals in which they provide care for people with dementia. 

Some of the factors mentioned above (e.g. time, cost, high staff turnover etc.) may result in some organisations being reluctant or unwilling to address certain care practices and situations which may be ethically challenging for their staff and for people with dementia in their care and/or to provide an appropriate and supportive atmosphere for the provision of ethical care. However, failure to address such issues may lead to an escalation of a challenging situation and have a negative impact on the physical and mental wellbeing of staff, people with dementia and informal carers.

It is essential that those responsible for the organisation/provision (rather than the direct/person-to-person delivery) of dementia care build an organisational ethical infrastructure (i.e. a general context/environment allowing ethical analysis and empowering professionals who have to tackle ethical dilemmas with skills and opportunities to share their thoughts).

The following suggestions may be helpful in this respect:

  • Build up a practice of moral deliberation/reflection.
  • Integrate this into your organisation’s vision and objectives.
  • Involve people with dementia and informal carers in your ethical infrastructure.
  • Consider teaming up with other organisations and sharing ethical expertise (e.g. an ethics advisor or ethics board) if yours currently lacks the necessary means.
  • Work on capacity building in ethics (e.g. training in ethics and in ethical reflection).
  • Provide staff with the necessary time and support to discuss ethically sensitive situations.
  • Create an environment in which staff will feel safe to reflect on situations.
  • Involve and value staff of all levels, not just those in higher positions, in your ethics committee.
  • Consider ethics in all work undertaken and in all reports.



Last Updated: Thursday 26 November 2015