Ethical issues in dental management of patients with severe dementia: ethical reasoning by hospital dentists. A narrative study.

Dementia alters the patient's ability to accept conventional dental treatment and conflict situations arise involving moral dilemmans in judgements and actions. The aim of the study is to disclose how the dentists think, feel and act in such conflict situations and their ethical reasoning. Qualitative methods are used in interpretation of 21 tape-recorded narratives from hospital dentists. In all narratives, the problem emerged from uncertainty about what comprise an appropriate treatment. The ethical dilemma could either be narrated as internal, within the dentist or external between the dentist's opinion and opinions to the contrary from co-actors in the story. In a climate of restraints in public spending in health care a discourse from the perspectives of ethics is essential to ensure respect for human integrity in society, fundamental for all caring, including dental care of patient with dementia.