<sec id="s1">Background: Paramedics are frequently called to people with dementia, but decision making can be challenging due to lack of information or difficulties in assessment. Best-practice dementia care should be holistic and involve people with dementia in decisions as far as possible. </sec> <sec id="s2">Aims: To explore how paramedics make decisions when attending people with dementia, with a particular focus on factors that impact on how, and to what degree, paramedics involve people with dementia in these decisions. </sec> <sec id="s3">Methods: A generic qualitative research approach was used. Data were collected through semi-structured individual interviews with seven paramedics. The interviews were recorded and transcribed verbatim and subsequently analysed using thematic analysis. </sec> <sec id="s4">Results: Four themes were identified that all touched on challenges to delivering person-centred care. Themes identified were: 1) paramedics’ differing approaches to assessing capacity and making best interest decisions; 2) communication and developing a rapport; 3) interconnections with others important to the person with dementia; and 4) the impact of paramedics’ values and attitudes. </sec> <sec id="s5">Conclusion: The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. This study highlights how paramedics’ values and communication skills influence their interactions with people with dementia. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics with the skills and ethical frameworks needed to deliver high quality dementia care. </sec>

The emergence of the Black Lives Matter movement in 2020 in the context of a COVID-19 pandemic that was already disproportionally impacting on the lives of people from black, Asian and other minority ethnicities in the UK and the US has provoked scrutiny of how racism impacts on all areas of our lives. This article will examine some competing theories of racism, and ask what theoretical tools we need to successfully confront racism in health and social care. In particular, it will scrutinise the different levels at which racism operates – individual, institutional and structural – and ask how these are related. Furthermore, it will argue against theories that see racism as a product of whiteness per se or ‘white supremacy’, insisting instead that racism should be understood as firmly bound to the functioning and perpetuation of capitalism.

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