Guiding Ethical Considerations

We will discuss clinical cultural competence by unpacking three concepts. We will then explore the significance of recognizing and honoring community memberships. There are many communities to which a person may belong, and we will discuss how membership in a community shapes dementia grief work, from an ethical perspective. We will then consider two ethical models that you can adopt in making decisions: Four-Box Method (Jonsen et al., Clinical ethics: A practical approach to ethical decisions in clinical medicine, 7th edn, McGraw-Hill Medical, 2010) and The Five P Model (Gamino and Ritter, Ethical practice in grief counseling, Springer Publishing Company, 2009). We will use a case vignette of Leonard to understand a practical application of The Five P Model. We will also ponder how perhaps blending of multiple models may be more useful or beneficial in integrative practice settings. I will then offer three other areas of ethical consideration: confidentiality, decision-making capacity, and the concept of assent. Within the second area, decision-making capacity, we will frame our discussion by considering three key areas: beneficence, autonomy, and informed decisions. The concept of informed decisions will be illustrated by Anne Reid Enio’s expressed end-of-life wishes through the application of the Five Wishes document. All of these ethical considerations are embedded in an appreciation for cultural competence.