Whether or not it is acceptable to lie to someone in the advanced stages of dementia is a moral dilemma faced by many carers.

Take, for example, the following two scenarios.

A woman with dementia is anxious because she believes her husband is late to pick her up. She doesn’t remember that her husband died many years ago. Previously, when similar concerns have come up, carers have told her that her husband is dead, which has resulted in the woman becoming upset and distressed. So this time, the woman’s carer tells her he’s at the shop and will be there soon, and asks her if she’d like a cup of tea. The woman is reassured and calm.

Consider also the wife who hides her husband’s car keys because doctors and authorities have told her it’s not safe for him to drive because he has advanced dementia. When she initially told him he can’t drive he became furious, so now she tells him she doesn’t know where the keys are.

In both these examples, carers have used ‘white lies’ or ‘therapeutic lies’ to prevent distress and agitation in a person who is living with advanced dementia.

By telling an untruth, the carers are in fact sparing the person from hurt, shock and sadness which they know would only cause pain, confusion and suffering.

Sometimes telling a ‘white lie’ can also help the interactions between carers and people living with dementia, because it may prevent the need for a person with dementia to communicate distress through stress-related responses such as anxiety or tearfulness.

Of course, lying is generally considered a ‘wrong’, and it is not acceptable to lie to people who still have the capacity to make decisions about matters you are discussing. This article relates to those with dementia who no longer have the capacity to make decisions.

Not ‘lies’ in the sense that we know them

Leah Bisiani, Dementia Consultant with Uplifting Dementia, told HelloCare that lies told to people with dementia are not really lies in the sense that we know them.

“I would contend that perhaps these so-called ‘white lies’ not be considered lies at all, since they are not a deliberate act to betray or trick,” she said.

Medical ethicist Maartje Shermer wrote that when someone is In the later stages of dementia they can no longer distinguish between reality and a falsehood, so in effect, it’s impossible to lie to them

“Once patients reach a state in which concepts such as true and false, reality and illusion, or fact and fantasy do not mean anything to them anymore it becomes logically impossible to deceive them or to lie to them,” she wrote.

Person centered care sometimes means respecting a different reality

Ms Bisiani said, “I argue that people living within their own inner world should never be forced out of it with a request to orientate to our truth and actuality, if all this will create for them is pain. This is regarded as gross neglect and betrays the spirit and ethos behind true person-centred care.

“Instead, are white lies possibly providing a compassionate authenticity for the person, where therapeutic privilege provides them with a means to participate in a role that is meaningful and rewarding to them?

“When attempting to understand a person living with dementia we endeavour to capture these differing viewpoints and scrutinize the clarification of what we observe. In this way we acknowledge, and thus support each person’s reality as ‘his or her own personal truth’.

“We must honour and respect these differing experiences and perceptions and aim to give these realities the ‘voice’ they deserve.”

Connecting profoundly and positively is “essentially right”

It’s important to acknowledge that carers sometimes tell ‘white lies’ to people who are in the advanced stages of dementia because that recognition can ease any concerns carers might have about the morality of what they are doing.

By discussing the topic we also have the opportunity to ensure it is done in the best way, and we open up opportunities for discussion.

“If we disregard the potential benefits of ‘validation’ regarding the emotional wellbeing of people living with dementia, then we may possibly jeopardize the stability of everyday life and the capacity to thrive,” said Ms Bisiani.

“Any intervention that connects positively with people living with dementia at a profound level is essentially right,” she said.

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