Emerging Ethical Issues in Dementia Care

Abstract

Abstract Alzheimer’s disease (AD) is a neurodegenerative condition affecting over 6 million Americans. As a disorder with no known cure or means of prevention, AD has been ranked the most feared disease among older adults. Despite recent advances in AD pharmacotherapeutics, most current FDA-approved treatments are regarded as symptomatic and do not prevent those affected from progressing to the final stages of dementia. Indeed, the overwhelming majority of dementia care provision remains nonpharmacological in nature and includes assisting individuals with the performance of instrumental and, as the disease progresses, basic activities of daily living (ADL), including medication taking, meal preparation, and self-care. ADL assistance as well as nonpharmacologic behavioral management of persons with AD can be distinctly characterized as nursing care. Nurses on the frontline of dementia care occupy a corresponding frontline role in the identification of and initial response to ethical dilemmas that manifest during dementia care. The purpose of this chapter is to review the shifting and expanding landscape of ethical issues in dementia care, and to argue that as the field transitions to an era of preventive care for AD, nurses will continue to have a key role in identifying and responding to emerging ethical dilemmas, including those arising during pre-test counseling for biomarker tests of AD risk. In doing so, the authors argue that a unique form of bias, called hypercognitivism, has not only tainted the extant bioethics literature on dementia, but represents a threat to the analysis of emerging issues in dementia ethics.