The decision to lie to a person who has dementia is complex and difficult. While caretakers or family members might feel guilty for lying to individuals who have been diagnosed with dementia, in certain situations, it is the best available option. For example, if a patient with dementia asks “How are my parents?” when their parents have passed away, it can sometimes be easier on everyone to say, “They are doing very well.”
What is Therapeutic Lying?
Therapeutic lying, also known as compassionate deception, is the practice of deceiving patients with dementia or other cognitive impairments to promote the well-being of the individual in their current reality. This strategy is used by caregivers to ensure emotional stability. Rather than lying to hurt or manipulate a person, these white lies can be used to help support an individual.
Ethical Considerations
Preserving their well-being
Lying to someone with dementia is sometimes the best choice a person can make. It is important that a caregiver chooses the correct response to reduce distress. If telling the truth would cause the person psychological or physical harm, then a caregiver would have to think of an alternative narrative.
Respecting their dignity
Honesty is typically a valued aspect of any sort of relationship. However, when it comes to dementia, insisting on honesty can cause unnecessary confusion or anxiety, since a person’s ability to remember and understand facts is impaired.
Intention and context
The intention behind a lie is what matters most when speaking with a dementia patient. If a person’s intention is to protect someone’s well-being and dignity, it can be viewed as a justifiable lie. However, if the intention behind the lie is for personal convenience, it is not as ethically justifiable.
Caregiver Judgment
Managing agitation or confusion
People diagnosed with dementia may experience confusion about their surroundings, such as not remembering where they are or who a person is. Redirection or lying might be the most compassionate option if correcting a dementia patient would cause them distress. For example, if a person is asking for a deceased relative, it might be easier to tell them, “They aren’t here right now, but they love you.”
Safety concerns
Lying might be necessary when it comes to protecting a person’s safety. If a person with dementia is not aware where they are or what time it is, they will not understand if it is safe or not. For example: A person might say, “It’s too late to go out right now, let’s stay inside where it’s safe.”
Respecting their reality
Individuals with dementia often live their own reality, which may differ from the actual events happening. Going along with the reality they are living in, rather than correcting them, can validate their feelings and prevent unnecessary confusion. For example, if a person with dementia believes they are on a cruise, asking about the ship or the food can be more beneficial than trying to correct them.
Alternatives to Lying
Despite the benefits of therapeutic lying, it is never easy to lie to a person with dementia, and it should not be taken lightly. In certain situations, it may be possible to use alternative methods to ensure the emotional stability of a person with dementia. Caregivers might consider using one or all of the following strategies:
- Validation: Recognizing and accepting a person with dementia’s emotions and comforting them can make them feel validated.
- Partial Truths: Simplified or partial truths can be used to maintain some level of honesty while reducing levels of distress or confusion.
- Distraction and Redirection: When sensing that a certain topic or question is causing distress to a person with dementia, redirecting their attention or changing the topic of conversation can be beneficial.
Conclusion
The goal of therapeutic lying is to reduce distress and enhance the quality of life for people living with dementia, while balancing the principles of honesty and compassion. Decisions regarding whether therapeutic lying is the best option should be made on a case-by-case basis. It is important to fully consider all possible options on how to handle a specific situation before resorting to this strategy. Given the nature of dementia, sometimes the best option is to lie, even though honesty is typically valued, in order to prevent causing more harm than good.
Sources
[1]https://www.washingtonpost.com/national/health-science/is-it-okay-tell-an-alzheimers-patient-a-white-lie/2018/03/16/41ab4afc-221a-11e8-badd-7c9f29a55815_story.html
[2]https://www.pegasusseniorliving.com/north-point-village/blog/2024/04/30/lying-to-a-person-with-dementia-memory-care-ethics/
[3]https://www.alzheimers.org.uk/blog/lying-to-someone-with-dementia#:~:text=Selecting%20the%20correct%20response%20to%20reduce%20distress&text=One%20consequence%20of%20this%20approach,significant%20physical%20or%20psychological%20harm.
[4]https://umcommunities.org/theshores/blog/why-its-ok-to-lie-to-someone-with-dementia/
