ABSTRACT

Sweden has been held up as one of the most advanced states when it comes to legal realisation of human rights for older persons with dementia, and there are national policies that propose how welfare professionals are to fulfil these rights. However, previous research has repeatedly shown that care managers in Sweden make decisions that leave these persons and their families without suitable interventions, which is especially problematic in cases of self-neglect (an inability to care for oneself combined with resistance to receiving care from others) when basic living standards for health and well-being are jeopardised. This problem is increasing around the world as dementia becomes more common, but there has been little national or international research on policies affecting this matter. This article examines how national policies in Sweden guide care managers to work ethically in cases of self-neglect among older persons with dementia. Through a policy narrative approach, the findings specify care ethical standards that aim to support decision-making abilities in such cases. The discussion dwells on how weaknesses in the identified narrative, in the context of dementia-associated self-neglect, can explain why these standards seem to have little impact on practice.

摘要

在法律上老年痴呆症患者的人权实现方面，瑞典一直被列为最先进的州之一，并且有一些国家政策提出了福利专业人员应如何实现这些权利的建议。但是，先前的研究反复表明，瑞典的护理经理会做出决定，使这些人及其家人没有适当的干预措施，这在自我忽视的情况下尤其成问题（无法照顾自己，以及抵制接受他人的照顾）危害健康的基本生活水平。随着痴呆变得越来越普遍，这个问题在世界范围内越来越严重，但是，关于影响这一问题的政策的国内或国际研究很少。本文探讨了瑞典的国家政策如何指导护理管理人员在老年痴呆症患者中自我忽视的情况下进行道德操守。通过政策叙事方法，研究结果指定了护理伦理标准，旨在支持此类情况下的决策能力。讨论集中在与痴呆相关的自我忽视的背景下，已确定的叙事中的弱点如何能够解释为什么这些标准似乎对实践几乎没有影响。