From autonomy to well-being: Reimagining ethics consultation in dementia

Respect for patient autonomy is a cornerstone of modern bioethics, yet the gap between ethical ideals and clinical practice remains pronounced. To bridge this divide, Björk and Hirsch have proposed the introduction of a new professional role: autonomy consultants. This essay critically examines the applicability of such a role within dementia care, a context characterized by progressive cognitive decline and irreversible alterations of personal identity. Using a philosophical and theoretical analysis, illustrated through a hypothetical clinical case study, this essay examines the conflict between a patient's historical autonomy and their situated well-being in the present. The results indicate that a strict bioethical focus on autonomy risks producing unintended consequences, including situations where attempts to preserve historical autonomy may contribute to distress for individuals with advanced dementia. Consequently, this essay argues for a conceptual reformulation of the role into a well-being consultant within dementia care. Rather than focusing primarily on autonomy, this role, grounded in care ethics and person-centered care, is proposed to function as a relational mediator who supports ethical reflection by integrating the patient's life history, present experiences, relationships, and well-being when conflicts arise between historical values and current care needs.