Dementia pt's don't "refuse" medications because they are confused and they simply don't know what it is you are doing, or what is it you are giving them exactly.
Suggesting there is some way to make them understand, when the reality of the matter is, this isn't even remotely possible to do in the first place because of their cognitive deficit medical condition. That is to say, it's simply not possible to make them understand.
However, I still fail to understand where the so called ethical dilemma situation exists exactly. All you are trying to do is provide them with the best medical treatment and personal care possible. That's all that should really matter at the end of the day isn't it?
Even though the cognitive impaired patient may not understand what I am doing, or what medication I am giving to them exactly, I would certainly never do anything that causes any harm to them, end of story!
I suspect those who have no previous experience working with the dementia population have no way of understanding the reality of the situation.
While I do sincerely support and appreciate the sentiment of ensuring the principles of ethical nursing practice is upheld, maintained and followed, you need to understand the world of nursing isn't exactly a matter of seeing everything in simple black and white either.