Learning Objective #1: Analyze situations of ethical conflict in providing daily care to a family member with dementia

Learning Objective #2: Increase awareness of the experience of suffering among caregivers of family members with dementia in situations of ethical conflict

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Reflecting on the relational approach to care ethics, Robinson (1999) suggests that this approach is able to address moral problems of human suffering by recognizing that the nature and patterns of personal and social relationships is the starting point for moral enquiry. Further, she states that this approach places a high moral value on the maintenance of relationship through continuous attention, responsiveness and care. However, the potential for exploitation and coercion exists within all relationships. A relational approach to care ethics considers the demands of a given situation where real social relations among concrete persons exist and need to be maintained.

This qualitative study was based on in-depth, open-ended interviews with 10 primary caregivers of family members with dementia at various points in the caregiving experience. The purpose of the study was to explore the ethical conflicts surrounding issues of relationship, obligation and dependency in everyday caregiving situations. Caregivers describe the importance of keeping safe through constant vigilance and reducing risks. Providing for physical well being and safety of a family member with dementia involved such strategies as decreasing their involvement in decision-making, restricting certain activities, securing the environment, coercion and reducing social access. These approaches were not without personal cost to the caregiver as they weighed the autonomy of their family member against potential risks.. Maintaining feelings of serenity and security for care receivers required such strategies as keeping secrets, or fabricating stories. Keeping a balance required a weighing of health issues and maintenance against the risk for inflicting greater harm through health assessment and treatment. Caregivers found their greatest strength in both making these ethically challenging decisions and coping with feelings of guilt in their deep-seated sense of spiritual connectedness and in the support of other caregivers like themselves.