How do you handle ethical questions?

[TatevikVfL]

When someone you love and deeply care about has dementia it's emotionally and physically overwhelming. Add in their vegan, vegetarian, or religious dietary needs. Suddenly, ensuring their choices are respected in a care setting becomes a major concern.
Some care homes give meat to vegans or vegetarians with dementia, saying they need more proteins. But what about the health risks? Red and processed meat are linked to cardiovascular diseases, hence dementia.
It gets even more challenging when, due to cognitive changes, your loved one starts asking for non-vegan meals or even pick from others' plates!
The Equality Act 2010 protects religion and belief. But the care home tells you your loved one wants meat? The question is: should vegans and vegetarians with dementia have their beliefs disregarded? Should their condition override their right to freedom of belief? Is it fair to treat someone differently just because they have dementia?

 

[northumbrian_k]

Hi @TatevikVfL and welcome to Dementia Support Forum our friendly and helpful community of people who have experience of many aspects of dementia. You raise an interesting ethical issue which may be hard to answer given the changes that dementia leads to in a person's behaviour, likes and dislikes, and even long-standing beliefs and life-style choices. Care homes can do their best to respond to what they know about a person (which in itself may be incomplete) but sometimes the person's behaviour and expressed wishes no longer fit with their pre-dementia selves.

My wife had not been in her care home long when I visited one Sunday. She had gone out with the activities co-ordinator having convinced them that she went to church every week. This was not the case. She never liked milk in her tea but drinks it that way now, with apparent relish.

These might seem trivial compared to, for example, giving up a longstanding commitment to veganism. But my simple point is that whether a person with dementia makes a conscious choice or has just forgotten something is difficult to tell. Should we, who can remember what the person would have done before dementia, act as arbiter of their choices if they seem to be at odds with what we know they (once) believed? Would that in itself be ethical?

 

[Jaded'n'faded]

Interesting question!

One thing to consider (or add to your dilemma!) is that often when someone has dementia their tastes change - many will be attracted by sweet foods when they weren't previously - my mum was certainly one and even started taking sugar in tea and coffee. Previously she had never liked tea at all and couldn't drink coffee with sugar in. And don't get me started on giant Chocolate Buttons...

I think the issue of the link between red meats and various diseases is not something that will matter much at this stage, unless your loved one already has dietary concerns.

I'm not sure a care home are right to say, 'He/she needs more protein so we're giving meat.' There are lots of other ways to increase protein intake without adding meat to a diet, so that's not much of an excuse on their part.

However... if he/she says they want meat and has developed a taste for it, is there really any harm in allowing it?

Just my opinion...

 

[try again]

I am a vegetarian and the thought that someone would decide otherwise on my behalf or if I develop dementia will change my mind fills me with horror. I must remember to amend my advanced directive!

 

[TatevikVfL]

Hi @Jaded'n'faded. Thank you for pointing out the changes in taste. I wasn't aware of that. I guess the answer to your question depends on what do you consider to be a harm to a person with dementia? Is it going to harm (or not) them or and perhaps their loved ones too? As you might now many people chose to become vegan or vegetarian for ethical, environmental reasons. It's a significant part of their identity.

 

[Jessbow]

I think a person with dementia shoud be given choices where appropriate.
Clearly it would be silly to allow a coeliac to eat wheat products because its a dietrty NEED
When something like vegetarianism & Veganism comes to play its a CHOICE.
Is there any reason why a person with dementia shouldnt choose for themselves?
Much as it may have been an ethical choice in their former life,do they still hold the same opinion now?

Once upon a tme, my mother wouldnt have eaten red meat. She woudnt have wandered about with no pants on, peeing on the floor either.

 

[northumbrian_k]

And, tragically, @TatevikVfL it is that very identity that dementia strips away. @Jessbow's final paragraph, if a little graphic, illustrates this well.

 

[TatevikVfL]

Hi @try again. I share you concerns. I am a vegetarian too.

 

[Sarasa]

I'm a vegetarian who tries to eat a mainly vegan diet so I would be horrified if a care home decided I 'needed' meat. I'd hope any care home I ended up in would respect that. I also think that in the later stages of dementia trying to ensure a healthy diet is less important than getting someone with dementia to eat at least something even if it is just sweets.

 

[Jessbow]

I'm a vegetarian who tries to eat a mainly vegan diet so I would be horrified if a care home decided I 'needed' meat. I'd hope any care home I ended up in would respect that. I also think that in the later stages of dementia trying to ensure a healthy diet is less important than getting someone with dementia to eat at least something even if it is just sweets.

Or Just a sausage roll or burger in a bun ..Thats exactly the thing.

 

[try again]

@Jessbow "Once upon a tme, my mother wouldnt have eaten red meat. She woudnt have wandered about with no pants on, peeing on the floor either."

There is a distinct difference between this and someone who has ethically decided to give up meat!
(Note to self: must learn how to quote properly!)

 

[jugglingmum]

I'm setting out at the top of my reply that I'm not a vegetarian, and rarely eat plant based meals.

I don't think at the stage of dementia we are talking about the health risks are relevant, the damage has been done, and dietary effects build up over years.

I do think that someone following a vegetarian or vegan diet should be provided with plant based alternatives to meat. Ensure drinks are available in vegan options. So meat isn't necessary to provide protein. And I've eaten a very nice plant based sausage patty in the last month. (Vegetarian cafe as no other available)

However if the PWD is helping themselves to meat off someone else's plate then I wouldn't think intervention would be appropriate.

And if they are deemed to have capacity to make food choices then this should be respected.

My mum would be horrified at some of the financial decisions she made but would have been deemed to have capacity (I don't agree with the whole capacity thing).

 

[Firecatcher]

I’ve been a vegan for most of my life and would definitely want my ethical choices respected. I’d be absolutely horrified if I was given meat or dairy products.

 

[try again]

My mother swore she always wanted to be buried with her dad.
this changed during her time with dementia and my sister and I have decided she will be cremated with no funeral but we will go up to Liverpool and arrange for her ashes to be buried in her father's grave .

 

[canary]

I dont think there are many care homes that would just give people who were vegan/vegetarian meals containing meat. Certainly the good ones would respect dietary requirements. However, in mums care home and when OH went into respite, residents were given choices about their meals. What happens when someone who is vegetarian chooses a meal with meal in it? Do you deny them that choice?

People with dementia change. I have read several threads about people with dementia who had always looked smart and took care of their clothes and appearance, but once dementia came along they no longer cared. One particular spouse said that they had lost what made them, them. I know that OH has lost some previously firmly held beliefs. Ive come across people who smoked in their younger days, but gave up and were vocal about the dangers of smoking, who, once dementia set in, went back to smoking again. It is difficult to reconcile the person they were with the person they are now.

I think that if someone is unable to make a choice about what they eat, then they should not be given food that contravenes previously held beliefs, but if they are able to choose, then I think it should be honoured, even if it is not what they would have previously chosen

 

[Lawson58]

When someone you love and deeply care about has dementia it's emotionally and physically overwhelming. Add in their vegan, vegetarian, or religious dietary needs. Suddenly, ensuring their choices are respected in a care setting becomes a major concern.
Some care homes give meat to vegans or vegetarians with dementia, saying they need more proteins. But what about the health risks? Red and processed meat are linked to cardiovascular diseases, hence dementia.
It gets even more challenging when, due to cognitive changes, your loved one starts asking for non-vegan meals or even pick from others' plates!
The Equality Act 2010 protects religion and belief. But the care home tells you your loved one wants meat? The question is: should vegans and vegetarians with dementia have their beliefs disregarded? Should their condition override their right to freedom of belief? Is it fair to treat someone differently just because they have dementia?

Saying that some care homes give meat to vegans or vegetarians because they need protein is a very generalised statement. If you have noticed the price of meat lately, I think they would have been happy to be able to keep their costs down .

I don’t think you can assume that a person with dementia holds the same beliefs as they did prior to developing dementia. I suspect that they don’t know what they believe anymore. I know my husband doesn’t really know what he thinks anymore either. If a person chooses to help themselves to a little meat from someone else’s plate, does any of us have the right to impose what we think a patient believed before on their choices now?

 

[Grannie G]

I would expect care homes to respect dietary cultures, whether they are vegetarian, vegan, halal and kosher, for halal and kosher, at least no pork.

 

[TatevikVfL]

Hi @Lawson58. You are right, meat products can be quite pricey. One might think that care homes would opt not to serve meat. However, the reality is quite different—it requires substantial effort to ensure that care homes adequately cater to the needs of vegans and vegetarians

 

[TatevikVfL]

Perhaps I should have explained it in more detail in my post. The concern is that even when the special dietary requirements of a person are noted on their care plan, the care homes do not always follow them. Unfortunately, I know of many instances when a person’s special dietary requirements were ignored, causing a lot of undue issues for them or their loved ones. I am struggling to understand why religious or philosophical beliefs are deemed secondary when the person can no longer voice their opinion due to dementia or health issues. I am a vegetarian. Like many others who share my beliefs, I am worried about what will happen the day I can no longer voice my needs or self-advocate.

 

[TatevikVfL]

Could it be that vegans and vegetarians with dementia are drawn to picking from other people's plates due to the food presentation rather than a craving for meat? For example, if you offer a vegan person with dementia a plate of overcooked, soggy vegetables.