Nursing people with dementia: an overview of ethical dilemmas and how to navigate them

Dementia affects cognition and therefore often results in people lacking mental capacity to make decisions about their treatment and care, resulting in decisions being made on their behalf. On such occasions, there may be differences of opinion between healthcare professionals and families, or between professionals themselves, about what constitutes the person's best interests. This is particularly the case in complex situations where the principles of biomedical ethics conflict with one another and there are no obvious 'right' or 'wrong' answers. This article outlines ethical principles in healthcare, discusses best interests decision-making and describes the so-called balance sheet approach. It also examines in more detail some ethical dilemmas commonly encountered in nursing practice when caring for people with dementia.