Ethical Challenges in the Dementia Care Triad: A Qualitative Study From a Danish Day Care Center.

Abstract

While research on the ethical challenges of dementia care has advanced significantly in recent years, research gaps remain that require further exploration. First, research has focused on specific ethical principles, such as autonomy. Second, it has largely examined ethical issues from a single perspective, focusing primarily on professional caregivers. Finally, research has been conducted in institutional settings, overlooking the challenges that arise in other contexts, such as day care centers (DCCs). This study investigates perceived ethical challenges in dementia care within a DCC from a triadic perspective, incorporating the voices of people with dementia, family caregivers, and professional caregivers. Using an exploratory qualitative approach, data were collected through participant observation and semi-structured interviews. Thematic analysis was employed to identify main themes, with the analyses informed by a combination of principlism and a narrative approach to ethics. The study, conducted at a Danish DCC, highlights three main ethical challenges: professionals' management of people with dementia's varying functional levels, collaboration between family and professional caregivers, and relationship dynamics between people with dementia and their family caregivers at home. These challenges are co-constructed, shaped by both individual and shared narratives, underscoring the need to consider all perspectives involved. Moreover, ethical challenges are context-dependent, varying across different care settings. This study emphasizes the importance of integrating a narrative care approach to ethics to fully capture the complexity of ethical dilemmas in dementia care.