From Ritual to Relationship

There is an increasingly relevant debate around consent, particularly around persons with a dementia, across research and practice. This article will begin by critically reviewing the traditional competency-based approach to informed consent in research with older people who have dementia. Currently, most researchers are not describing how persons with dementia are included in the consent process other than through an extension of the traditional competency-based informed consent method. As yet there is little in the way of academic publications on developing methodologies or practical methods of inclusionary consent, despite the rapid development of so-called person-centred participatory research in dementia. The remainder of the article will describe work in progress on a theoretical foundation and an evolving method for including persons with dementia in consent processes. The article concludes that a revisionist person-centred inclusionary approach to consent, which values the interests of all parties involved, including the person with dementia, is a way forward in person-centred research. It is also suggested that dementia-friendly methods must be more rigorously tested and reported.

[1]  S. Eckstein The ethical conduct of research on the mentally incapacitated , 2003 .

[2]  Advance directives in dementia care: from instructions to instruments. , 2001, Patient education and counseling.

[3]  J. Dewing,et al.  A multi-method evaluation of an independent dementia care service and its approach , 2001, Aging & mental health.

[4]  B. Gillies A memory like clockwork: Accounts of living through dementia , 2000 .

[5]  Including the Person with Dementia in Designing and Delivering Care: 'I Need to Be Me!' , 2000 .

[6]  A Botes,et al.  A comparison between the ethics of justice and the ethics of care. , 2000, Journal of advanced nursing.

[7]  Claire Bamford,et al.  Defining the outcomes of community care: the perspectives of older people with dementia and their carers , 2000, Ageing and Society.

[8]  C. Clarke,et al.  Dementia Care: Developing Partnerships in Practice , 1999 .

[9]  C. Williams,et al.  Persistence of self in advanced Alzheimer's disease. , 1999, Image--the journal of nursing scholarship.

[10]  D. Brooker,et al.  Staff and patient feedback in mental health services for older people. , 1998, Quality in health care : QHC.

[11]  M. Kapp Persons With Dementia as “Liability Magnets”: Ethical Implications , 1998, The Journal of Clinical Ethics.

[12]  S. Sabat,et al.  Voices of Alzheimer’s Disease Sufferers: A Call for Treatment Based on Personhood , 1998, The Journal of Clinical Ethics.

[13]  S. Edwards Philosophical Issues in Nursing , 1998 .

[14]  Lyman Ka,et al.  Living with Alzheimer's disease: the creation of meaning among persons with dementia. , 1998, The Journal of clinical ethics.

[15]  Murna Downs,et al.  The Emergence of the Person in Dementia Research , 1997, Ageing and Society.

[16]  T. Kitwood,et al.  Dementia Reconsidered: the Person Comes First , 1997 .

[17]  M. J. Larrabee An Ethic of Care : Feminist and Interdisciplinary Perspectives , 1996 .

[18]  P. Whitehouse,et al.  Fairhill Guidelines on Ethics of the Care of People With Alzheimer's Disease: A Clinical Summary * , 1995, Journal of the American Geriatrics Society.

[19]  S. Post Alzheimer Disease and the "Then" Self , 1995, Kennedy Institute of Ethics journal.

[20]  J. Crisp Making sense of the stories that people with Alzheimer's tell: a journey with my mother. , 1995, Nursing inquiry.

[21]  T. Kitwood Exploring the ethics of dementia research: A response to berghmans and ter meulen: A psychosocial perspective , 1995 .

[22]  L. Sutton,et al.  Dementia in acute units: communication. , 1994, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[23]  S. Post Alzheimer's disease. Ethics and the progression of dementia. , 1994, Clinics in geriatric medicine.

[24]  C. Johns The Burford NDU model : caring in practice , 1994 .

[25]  L. Gwyther,et al.  Special care unit research: ethical issues. , 1994, Alzheimer Disease and Associated Disorders.

[26]  R. Dresser Missing persons: legal perceptions of incompetent patients. , 1994, Rutgers law review.

[27]  R. Schulz,et al.  The perspective of the patient with Alzheimer's disease: a neglected dimension of dementia research. , 1993, The Gerontologist.

[28]  John Bond,et al.  The medicalization of dementia , 1992 .

[29]  T. Kitwood,et al.  Towards a Theory of Dementia Care: Personhood and Well-being , 1992, Ageing and Society.

[30]  E. Kittay,et al.  Women and Moral Theory , 1989 .

[31]  Carol Gilligan,et al.  Moral orientation and moral development , 1987 .

[32]  H. Moody Issues of Equity in the Selection of Subjects for Experimental Research on Senile Dementia of the Alzheimer’s Type , 1985 .

[33]  C. Gilligan In a Different Voice. Psychological Theory and Women’s Development. Cambridge, MA (Harvard University Press) 1982. , 1982 .

[34]  Carol Gilligan,et al.  Woman's Place in Man's Life Cycle , 1979 .

[35]  H. Gadamer,et al.  Truth and Method , 1960 .

[36]  G. Dworkin Autonomy and behavior control. , 1976, The Hastings Center report.

[37]  Thomas Nagel,et al.  The Possibility of Altruism , 1970 .