title: A cross cultural review of the ethical issues in dementia care in Kerala, India and The Netherlands.
abstract: BACKGROUND
  The paper explores the diverse ethical issues in the care of persons with dementia, in the Netherlands and Kerala, India. These cross-cultural data are used to suggest newer ways for addressing the ethical issues in a mutually enhancing manner.
  
  
  METHODS
  A thorough review of the literature focusing on ethical aspects of the care for persons with dementia.
  
  
  RESULTS
  The medical paradigm is dominant in the Netherlands and awareness of dementia as an organic brain disease is low in Kerala. Institutionalized care is more common in the Netherlands and home-based care is the norm in Kerala. Institutional care is costly, whereas home-based care is stressful for caregivers. The advanced directive plays an influential role in the Netherlands, but this mechanism is yet to evolve in Kerala. The legal and social setting of the Netherlands has a strong influence on physician decision-making concerning end of life issues. In Kerala, discussion of these matters is nearly unknown.
  
  
  CONCLUSIONS
  Limited awareness of dementia in Kerala should be addressed in public forums, which can then be used to garner governmental support. The predominantly institutional model of care-giving in the Netherlands and home-based care-giving in Kerala, each have their strengths; policy makers in both societies can usefully apply the values and merits inherent in both models. A culturally appropriate implementation of the advanced directive will have beneficial medical, social, and economic impacts in Kerala. The remarkable disparity between the Netherlands and Kerala in dealing with end-of-life issues will allow more philosophically and socially informed ways of addressing the ethical questions that arise in those situations.
authors.affiliation: HRRC/ICMR, Department of Obstetrics and Gynaecology Medical College, Trivandrum, Kerala, India. sowminicv@gmail.com
authors.forename: C V
authors.initials: CV
authors.lastname: Sowmini
authors.forename: Raymond
authors.initials: R
authors.lastname: De Vries
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D003431:Cross-Cultural Comparison; D003657:Decision Making / Q000941:ethics*; D003704:Dementia / Q000191:economics / Q000208:ethnology / Q000628:therapy*; D005260:Female; D006291:Health Policy / Q000191:economics / Q000331:legislation & jurisprudence; D006299:Health Services for the Aged / Q000191:economics / Q000941:ethics*; D006699:Home Care Services; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes; D010166:Palliative Care / Q000191:economics / Q000941:ethics*; D013315:Stress, Psychological / Q000191:economics / Q000208:ethnology / Q000523:psychology