Ethical Principles and Frameworks in Dementia Care: A Scoping Review

Providing ethical care for people living with dementia is essential for safeguarding their rights, dignity, and well-being. However, ethical decision-making in dementia care is complex, often involving tensions between competing moral claims such as autonomy, beneficence, nonmaleficence, justice, and non-discrimination. This scoping review aimed to map and describe the ethical principles, related normative considerations, and ethical frameworks discussed in the scientific literature on dementia care, and to identify how these have been conceptualized. Following the methodological guidance of Arksey and O'Malley (2005), Levac et al. (2010), and Peters et al. (2021, 2022), a comprehensive search across five databases (Web of Science, Scopus, CINAHL, Medline/PubMed, and PsycInfo) identified peer-reviewed papers published in English. In total, 388 papers published between 1981 and 2024 were included. The results revealed a wide range of ethical principles and related normative considerations frequently cited in the literature, although they were typically discussed in an isolated way without reference to other principles or broader ethical frameworks. In contrast, ethical frameworks were mentioned far less often, and when they were, they mostly reflected traditional approaches such as principlism. Four gaps were identified: the plurality of ethical frameworks and limited conceptual integration underpinning dementia care research and practice; insufficient attention to ethnic and socioeconomic diversity among people living with dementia; limited consideration of diverse care settings and geographical regions; and the limited inclusion of people living with dementia themselves in the studies reviewed. These findings underscore the need for conceptually integrative, inclusive, and context-sensitive approaches to dementia care ethics that can better inform both ethical reflection and care practices.