Ethical Dimensions of Communication

Communication in dementia care raises important ethical considerations that require thoughtful reflection and practice.

Dignity and Respect in Communication

Maintaining dignity through communication is fundamental:

Language and Labeling

• Using person-first language (“person with dementia” rather than “dementia patient”)
• Avoiding infantilizing terms and tones
• Refraining from discussing the person as if they are not present
• Being mindful of potentially stigmatizing terminology
• Respecting privacy in discussions about care needs

Truth-Telling and Therapeutic Communication

Balancing honesty with compassion creates ethical tensions:

• Determining when correcting misconceptions is beneficial versus harmful
• Using validation rather than “therapeutic lying” when possible
• Considering the emotional impact of information
• Respecting the person’s right to information about their condition
• Adapting information to cognitive ability without infantilizing

Consent and Autonomy in Communication

Supporting autonomy through communication involves:

• Providing information in accessible formats
• Assessing comprehension of information provided
• Recognizing the capacity for supported decision-making
• Honoring communication that expresses preferences
• Advocating for the person’s voice in care planning
• Ensuring that “no” responses are respected when possible

Supporting Personhood Through Communication

Communication practices fundamentally support or undermine personhood:

Recognition and Acknowledgment

• Greeting the person by name
• Making eye contact and acknowledging presence
• Showing interest in the person’s experiences and feelings
• Validating emotional experiences
• Recognizing expressed preferences

Enabling and Supporting

• Providing time for communication attempts
• Supporting word-finding without taking over
• Offering communication aids when helpful
• Adjusting communication to support strengths
• Creating opportunities for successful communication

Including and Belonging

• Facilitating group participation through supportive communication
• Ensuring the person is included in conversations about them
• Supporting continued social connection through adapted communication
• Adapting family and social interactions to maintain relationships
• Creating inclusive communication environments

Research by Kontos et al. emphasizes that communication practices either support or undermine personhood, with significant implications for well-being. Their observational study demonstrated that interactions supporting personhood through communication were associated with increased positive affect, engagement, and reduced agitation (Kontos et al. 1013).