Ethical dilemmas in the care of patients with Alzheimer's disease and related dementias unable to give informed consent: positioning Lebanon within the Global North-South context.

BACKGROUND: As dementia progresses, individuals with Alzheimer's disease and related forms of dementia often lose decision-making capacity, raising complex ethical challenges related to autonomy, surrogate decision-making, dignity, privacy, and justice. This review examines the dilemmas in caring for patients who are no longer capable of providing informed consent, comparing Lebanon's situation with those of countries across the Global North and South, and proposes practical, culturally grounded recommendations for improvement. OBJECTIVE: To conduct a comprehensive thematic review comparing international practices with Lebanon's ethical, legal, and institutional approaches to caring for individuals with advanced dementia who lack capacity. METHODS: A systematic yet flexible review approach, guided by the PRISMA framework, was applied. Studies focusing on Alzheimer's disease and other related dementias were retrieved from PubMed, Scopus, PsycINFO, Web of Science, and the Cochrane Library up to April 2025. A total of 121 studies, including 112 international and 9 from Lebanon, met the inclusion criteria. These included qualitative, quantitative, and policy sources. Studies were thematically analyzed for ethical relevance across five themes. RESULTS: Five major ethical themes emerged: surrogate decision-making, patient autonomy, surveillance and technology, legal frameworks, and cultural and economic factors. A clear North-South divide was observed, with countries in the Global North generally relying on formal legal safeguards, advance directives, and structured institutional ethics oversight. In contrast, Lebanon and comparable countries in the Global South often operated with informal, family-centered models, limited legal clarity, and minimal institutional ethics support. CONCLUSION: Lebanon reflects broader Global South patterns: strong familial caregiving traditions, but inadequate legal and institutional frameworks to ensure dignity-based, ethically consistent care. This review proposes culturally sensitive reforms in law, public education, and ethics infrastructure to better protect the rights and dignity of individuals with advanced dementia.