Introduction
Care ethics, or what is openly known as the ethics of care, is concerned with the moral significance found in the fundamental elements of dependencies and relationships in human life.[i] The implication is that the ethics of care consist of a linkage between various parties and that the relationship works towards improving the welfare of the recipients. From a normative angle, care ethics works to maintain these associations by contextualizing and consequently promoting the well-being of both the care-receiver and the caregiver. It is described as a practice as opposed to a theory in several instances. Care involves understanding the needs and the world of others as well as oneself. The concept builds on the aspects of caring for the needy and vulnerable in the society. Besides, it is inspired by the realization of self and the memory of being cared. Care ethics has increasingly gaining ground in the healthcare sector with the theory.[ii] On a similar note, medical correlates such as research, healthcare education, and administration among others have also grown at a fast rate. The changes that have been happening in the healthcare sector need to be guided by ethical considerations because unethical practices pose grave risks to the whole system; thus, proper adherence to care ethics improves the welfare of both the caregiver and the care-receiver.
Healthcare is one of the fields that may be greatly affected by ethical changes as it has impacts on the central domains of human life. The key consideration in bioethics is that it addresses issues relating to healthcare ethics.[iii] Bioethics encompasses the approaches that seek to rationalize the moral conflicts that are acceptable in certain circumstances, and which, by extension, may require special consideration in instances where they are combined with other values.[iv] Various ethical theories may be used in such situations. Consequentialism, for instance, considers the outcomes expected once a given intervention, such as a happiness, is implementation. The deontology model, on its part, emphasizes intentions or duties. Caregivers and receivers are expected to execute certain functions including the duty not to lie to maintain moral ethics. The interests of the beneficiaries and the caregivers have to be considered in deciding the approach that should be taken into contemplation in this relationship. Bioethics applies in diverse situations and its scope has been expanding.[v] The concept touches on extensive areas in healthcare circles and influences the decisions made within the sector. This paper examines the application of care ethics in the context of healthcare. It is separated into various sections and subsections. The first section investigates on the care ethics, while the second section introduces the aspect of dementia patients. The other sections of this paper recognizes the importance of palliative care approaches as the major ethical approaches that clinicians use to enhance care ethics to patients with advanced dementia conditions. The discussion ends with a conclusion on the contributions of care ethics to bioethics
Ethics of Care
This section will discuss how human nature relates to care ethics, the aspect of embodiment, and particularity, and ethical considerations.
Care Ethics and Human Nature
It is difficult to avoid ethical decisions since ethical issues structure human lives. People hold theoretical suppositions concerning the acceptable diverse human actions. These beliefs influence the choices they make as they structure their lives in social and personal ways. Accordingly, theoretical reflection can help individuals avoid making decisions that may undermine a decent moral livelihood. Human life relies on the social structures of care. These structures not only protect the vulnerable individuals but also reflect a precise understanding of the significance of care. There is no objective assessment of any issue. Instead, all perspectives are equally and utterly subjective. The assessment of an ethical issue involves both values and facts. As such, values can make individuals to reconsider the truth. Even though both values and facts exist, the latter are value neutral and objective, and the former are value-laden and subjective.[vi] However, there are some realms of rational inquiry where objectivity needs a specific value orientation.
The ethics of care entails an inclusive assessment of ethical behavior. In turn, it also approaches moral behavior in the framework of care relationships. This relational and contextual sensitivity is typical for the ethics of care. Consequently, this implies that the set of standards remains closely associated with actual care practices. It also closely observes the ways through which responsibility develops. The worth of care refers to a number of positive conditions. This may include attending to the patient’s needs, the responsibility towards meeting such needs, and the competence and responsiveness of the caregiver.[vii]
Rational ethical reflection is practical in nature. When engaging in such a deliberation, there is a need to determine the actions to take. Consequently, it becomes challenging to deliberate without making suppositions about values. However, this does not imply that such deliberation is an issue of purely subjective view. The activities, which are necessary to human life continuance are vital and involve caring. Philosophical tradition significantly relegates the activities of care to the subhuman. Besides, these activities are central to human existence, and their exclusion affect philosophical theorizing. The given care aims at the complete emotional, intellectual, spiritual, as well as physical well-being of the patients.[viii] Such a care is offered in the setting of social structures, which encourage the nurturing of the capabilities to receive and give the care.
The ethics of care should possess a value-loaded content from which standards are applied to assess the outcome. Care should refer to the values and norms that criticize care practices, as well as advance them. The anthropology upon which the ethics of care is based is dominated by intersubjectivity. This needs an intersubjective care vision where empathy and compassion matter. The foundational perspective on the patient is value-loaded and possesses a normative content. From the personalism view, good care offers the chance to map theological and philosophical-ethical care aspects. In view of that, this makes the person a subject and historical being.[ix]
Particularity and Embodiment
Care is essential to the ethics of care. It holds an integral place in ethical theory due to its indispensability for human life. Without care relationships, human life could end. Care cannot be equated with simply having a common emotional view of concern for another’s well-being. Care is ever connected with the active willingness to help others in suitable circumstances. However, care cannot remain at the attitude level since human beings are not just intellects that interact. Instead, they are physical beings who have certain physical limitations and resources. Accordingly, embodiment plays a key role in care ethics. Individuals tend to have a wrong understanding of care ethics. Often, this occurs when they assume that morality relates to disembodied consciousness. Instead, morality stems from the people’s experiences. Care should involve a real concern with the psychosocial and physical needs if it is to offer a sufficient justification of the moral realm.[x]
Embodied existence is vital for understanding the nature of human development. Human life should be structured to offer the required physical care and support, as well as a social system, which transfers such care. Embodiment demands that care ethics take physical benefits and harms seriously as moral concerns. The embodiment is a vital element of the concept of particularity. Every individual has a different view of the world. Such attitudes are shaped by their physical being alongside their relationship with others and the world. The embodiment is also closely related to the concept that human beings are limited and interdependent. Ultimately, mutual respect is a fundamental element when offering care.[xi]
Dementia Patients
Background
Dementia condition is a common neuro system condition where the patients suffer from problems such as memory damage, cognition, and behavior. If the illness progresses, the diagnosed individual is likely to rely on the help from his or her family members or even becomes disable as dementia affects the individuals’ body system.[xii] As time goes, dementia patients become extremely weakened to an extent the illness becomes life threatening. Statistics from the 2015 reports shows that all over the world, 35.6 million people have dementia and healthcare researchers expect the prevalence of dementia to double in the future.[xiii] This implies that dementia is a condition that has healthcare needs that are comparable with other fatal illnesses such as cancer, heart failure, asthma, as well as arthritis.
Approaches to Ethical Care
Today, in the healthcare system, the ethical approaches to care are viewed as critical component that are making the care providers deliver their services in certain standards. For people with dementia, an ethical for care is the pathway that is used to plan their future and to make their life easier.[xiv] The ethical approaches to care are helpful to the healthcare staffs, the patient, and the family members related to the patients diagnosed with the different type of diseases. Many healthcare in the modern days uses complementary and descriptive ethical approaches, as these approaches are considerate to both the healthcare and the individual seeking health care services.[xv] In any case where the clinicians use a different type of approach to addresses treatments that are associated with ethical issues, timely and advanced diagnosis are made, which is an important practice for patients with fatal illnesses.
On the other hand, the growing number of people diagnosed with dementia is intensifying the ethical issues within the healthcare system. Most of the ethical approaches that the healthcare organizations are using for patients with dementia are normative and complementary.[xvi] These approaches examine what is considered right or good during the treatment of patients with advanced dementia conditions. In addition, some of the approaches that the healthcare clinicians use when making decisions on dementia patients are more descriptive in that they focus on examining the belief of the people and the way they act without reference to standards.[xvii]
Palliative Care
Palliative Care As an Approach to Enhance Bioethics Issues
In the recent years, clinicians have believed that palliative care approach is the best support for people with dementia conditions.[xviii] According to the World Health Organization, a palliative care approach is a medical method that healthcare organizations can use to improve the quality of life of patients who are facing the problem of healthcare problems with lethal illness.[xix] When physicians use the palliative care approach to treating dementia patients, they initiate treatment measures by means of prevention and relief of suffering through early identification, impeccable analysis, and treatment of physical and psychosocial problems. Accumulated research shows that if doctors institute palliative care timely, they get in a better position to distress the dementia symptoms in terminal stages, avoids toxicities of therapy, and improves the quality of life remaining.[xx] With this understanding, it is important for physicians to consider ethical issues that palliative care approach clusters, especially when it comes to making the decision on whether to use the approach or to consider other treatment methods for patients with dementia.
Applicability of Palliative Care Approach
Literature shows that dementia is a terminal condition, and its treatment should be focused on improving the quality of life and maintaining the comfort of patients’ life.[xxi] The patients should be the baseline of palliative care approach, as this will allow the care providers to be inclusive when they start the treatment process. The dementia patient’s family members should be included during the treatment stage in that the physician uses them as referrals for treatment of dementia symptoms and any other health care problems that relate to the condition. Palliative care approach is well used for people with the need of care regardless of their whereabouts.[xxii] In this point, it means that palliative care approach can be incorporated into the care for home residents diagnosed with fatal illnesses such as dementia and cancer. When patients at home are treated through palliative care, the clinicians increase the knowledge, skills, and confidence of the people receiving the care. Hence, the main aim of demetia treatment must be providing a patient with the highest level of comfort and quality of life.
Moreover, palliative care has become one of the most adaptable treatment approaches to people with life-threatening illnesses, as the method has rare side effects or problems.[xxiii] For this reason, the approach is being implemented in many hospitals to treat patients across all age groups. The number of healthcare palliative care programs has increased by 157% in the modern hospitals, as many healthcare settings understand that palliative care approach may benefit a large number patient in the ICU, emergency departments, and patients who have lethal illnesses.[xxiv] Therefore, it can be noted that healthcare organizations are aware of the importance of palliative care approach and the implementation of these programs is set in a standard way for effectiveness.
Ethical Consideration
Ethical Framework
Palliative care approach becomes an ethical supporting method of the treatment of patients with dementia because it is known for its benefit of underpinning the belief about the value of the individual with dementia.[xxv] This means that when the care providers use the palliative care approach in curing dementia patients, they consider the important aspects of their being, mostly their mental and physical well-being, patient’s logic of self-cultural, and social background. In turn, a further issue that stems from the use of palliative care approach in terms of the ethical framework is that the method recognizes the autonomy of a person with dementia and paying attention to the well-being of the care providers.[xxvi] As such, from the understanding of this approach, it is evident that palliative care is based on a person who is receiving the care services and the context of their family. When the dementia people and their family are involved in the palliative approach, it makes the care services approach to become consequential and enhance the healthcare system to initiate treatment services in an ethical manner.
Principalism
At the same time, palliative care clusters principlism as an approach for ethical decision-making that is focused on moral principles. This is to say that palliative care allows doctors to treat dementia patient under common ground of self-sufficiency, benevolence, and justice.[xxvii] In this context, the treatment decisions through palliative care are made with respect to the patients’ choice and self-determination. For example, palliative care allows patients to choose what medical treatments they need or the one that they do not want to receive. This makes the healthcare staffs respect the right of the patients, which is perceived as an ethical framework.[xxviii] As palliative care approach is promoting the aspect of doing the best thing (Beneficence), this makes the approach cluster moral structure and the nurses treat dementia patients in the best way possible. The approach becomes more ethical as it requires clinician to carry out their duties in a way that will show justice and fairness. It is entirely ethical when dementia patients receive care services in a fairness way, especially when they are being given care resources fairly. Finally, palliative care approach is based on the communication between the healthcare provider and the patient with dementia. In essence, it is within the ethical communication framework where clinicians understand the values of the patients with dementia and make a decision on concerning treatment procedures.[xxix] The communication values make palliative care approach compatible to care services, as clinicians understand the different opinions about whether an individual with dementia illness should receive treatment services immediately or being cared for later.[xxx] Consequently, this shows how ethical doctors and nurses treating dementia patients are since the treatment decisions are based on referral opinions, as well as the patients’ perspectives.
Conclusion
The concept of relations is critical in the ethics of care. Each relationship involves at least two people and may at times bring about mutual commitment to the welfare of each other. The caregiver is expected to observe certain ethical standards while delivering health services to the patient. Ethical considerations depend on several stipulations such as legality and privacy, as well as the decision-making process. The needs and interests of a patient need be taken into account before initiating any interventions. Bioethics stipulates the importance of this ethical consideration in the event of treatment and ensures that each party is fully aware of the ethical issues surrounding the decision-making process. Within healthcare circles, ethical standards are highly vital as they determine the kind of service offered to patients. They guide and direct individuals towards ensuring smooth operation aimed at safeguarding the welfare of all the parties involved in the care process. Overall, ethics safeguard the rights of the patient, as well as those of the caregiver.
From this discussion, it is apparent that palliative care approach is a well-established method that doctors and clinicians are using to initiate care services for people with dementia. By far most, palliative care is an essential method that healthcare organization can use to enhance bioethics issues. Thus, to deal with problems of patients values and identity, healthcare and policymakers should make an effort of implementing palliative care programs, as this will make the doctors maximize the freedom of the patients, enhance monitoring, and minimize the risks that are associated with fatal illnesses such dementia.
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[i] Steven D. Edwards. “Is There a Distinctive Care Ethics?” Nursing Ethics 18, no. 2 (2011): 185.
[ii] Steven D. Edwards. “Is There a Distinctive Care Ethics?” Nursing Ethics 18, no. 2 (2011): 185.
[iii] Virginia Held, The Ethics of Care: Personal, Political, and Global (Oxford: Oxford University Press, (2006), 43.
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[v] Joan C. Tronto, Moral Boundaries: A Political Argument for an Ethic of Care (New York: Routledge, (1993), 24.
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[xi] Groenhout, Ruth E. Connected lives: human nature and an ethics of care. Lanham, MD: Rowman & Littlefield Publishers, 2004.
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[xiii] Aquilina, Francesca Falzon, and Mark Agius. “Palliative Care in Dementia.” Psychiatria Danubina 27, no. 1 (2015): 506.
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[xvi] Whitehouse, Peter. “Ethical issues in dementia.” Dialogues Clin Neurosci 2 no 2, (2000) 164
[xvii] Whitehouse, Peter. “Ethical issues in dementia.” Dialogues Clin Neurosci 2 no 2, (2000) 164
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[xx] Mohanti, Bidhu K. “Ethics in palliative care.” Indian journal of palliative care 15, no. 2 (2009): 90.
[xxi] Aquilina, Francesca Falzon, and Mark Agius. “Palliative Care in Dementia.” Psychiatria Danubina 27, no. 1 (2015): 507.
[xxii] Roberts, Della, and Gina Gaspard. “A palliative approach to care of residents with dementia: Della Roberts and Gina Gaspard evaluate a workshop that used critical reflection to help healthcare providers review their end of life strategies.” Nursing older people 25, no. 2 (2013): 33.
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[xxiv] Hartjes, Tonja M., and Jan Foster. Palliative Care in Critical Care. Philadelphia, Pennsylvania : Elsevier 2015. 291.
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[xxviii] Byrne, Judi. Palliative Care in Neurological Disease: A Team Approach. Oxford: Radcliffe Pub, 2009. 114.
[xxix] Woods, Simon. Death’s Dominion: Ethics at the End of Life. Maidenhead: Open Univ. Press, 2007. 102.
[xxx] Ashby, Michael, and Brian Stoffell. “Artificial hydration and alimentation at the end of life: a reply to Craig.” Journal of medical ethics 21, no. 3 (1995): 139.
