Ethically challenging situations faced by professional carers of people with dementia: training materials and the need for an organizational ethical infrastructure

Context, aims and objectives:Caring for people with dementia in an ethical manner is not an option but a fundamental component of good care. However, professional carers of people with dementia in care homes and hospital settings sometimes find themselves in situations in which it is hard to decide what, if anything, would be the right thing to do. It is particularly difficult to make such decisions when each possible option seems to be good for some people but not for others. In addition, professional carers may hold very different ideas about what is (morally) right or and on what basis a certain approach would or would not be ethically justifiable. Such issues are further complicated when acting ethically in the context of professional dementia care is incompatible with respecting established professional and institutional procedures or formal guidelines for care. Although the wellbeing of the person with dementia must be the central concern when providing care in care homes and hospitals, this must be balanced against other concerns related to the wellbeing and rights of other people such as informal carers (i.e. relatives and friends), co-residents with and without dementia and professional carers. In everyday practice, it can sometimes be a challenge to achieve this.Achieving ethical care and learning how to deal with such situations takes place in a particular working environment, which is affected by a range of factors such as staffing levels, skills and training, collaboration with colleagues, the hierarchical structure, budgets, laws and organisational procedures. Despite these constraints, which determine to some extent the range of actions options available to individuals and teams, health and social care professionals must accept personal responsibility for ethical care and address ethical dilemmas and challenging situations when encountered. To achieve this, they must be able to count on the support of their organisation. Ethical care must be a priority for those responsible for running the care homes and hospitals in which they provide care for people with dementia. It is essential that those responsible for the organisation/provision (rather than the direct/person-to-person delivery) of dementia care build an organisational ethical infrastructure (i.e. a general context/environment allowing ethical analysis and empowering professionals who have to tackle ethical dilemmas with skills and opportunities to share their thoughts).The objectives