ETHICAL AND LEGAL ISSUES
A number of ethical principles underpin the way we lead our lives. One of the most important of these is autonomy, which is the individual's right to be self-governing, in other words to exercise self-direction, freedom and moral independence. Because dementia fundamentally impairs the capacity of an individual to be autonomous, many ethical and legal problems that arise in dementia care occur around this principle due to conflicts involving decision-making capacity. For example, competency to manage finances, to drive a car, to participate in research and to decide where to live are common areas of concern, discussed later in this chapter.
Other ethical principles that have direct bearing on many of these situations also need to be considered. For carers and health professionals, beneficence, which means doing good or conferring benefits that enhance personal or social well-being, and nonmaleficence, which means doing no harm, are often the ethical basis of the care being provided. Sometimes these principles may come into conflict and at these times the principle of justice may come into play. Justice is about fairness and impartiality and the need to find a balance between competing interests; examples include balancing the desire of the dementing person to live alone in their own home with the concerns of carers about hygiene and safety, and balancing the potential benefits of a drug treatment against the risk of serious side-effects. Ultimately, when a dementing person is found to be incompetent to make a particular decision, it is essential that the needs of the dementing person, rather than the needs of carers, health professionals or others, be