My father had hypoxic dementia due to a cardiac surgery gone amiss. When I sat with him in the garden at his rehabilitation center, he repeatedly asked to see his parents.
My father was 75. His parents had been dead for over 30 years.
My repeated and — in retrospect — cruel reminders caused his eyes to tear up.
“Nothing’s going right for me here,” he said, after I informed him his parents were dead.
Instead of brutalizing my father over and over with the truth, I might have lied.
“Your mother and father had to run to the market. We’ll see them later today.”
The act of deliberately telling untruths to Alzheimer’s and dementia patients in order to alleviate or avoid emotionally stressful topics is called Therapeutic Lying.
A confused patient who can’t understand that she is forbidden to receive anything by mouth, may demand a cup of coffee. An abrupt, “No, you can’t have it,” might engender rage and disbelief.
“I’ve ordered coffee and a girl should be bringing it up soon,” can avoid frustrating the desire for coffee in a person who will shortly forget the request.
Dr. Anthony McElveen, a psychiatrist, advocates therapeutic lying in order to enter into the reality of the patient and avoid the agitation and frustration that comes with constant correction.
McElveen promotes therapeutic lying in the following instances:
- To prevent distress and agitation.
- To prevent harm and keep individuals safe
- To enhance the overall well-being of the person with dementia.
McElveen wrote in a paper published by the Royal College of Psychiatrists, “ ... if the function of truth in a situation is to bring nothing but pain and distress to a confused, demented fellow human being, then its utilization in that instance is at best futile, at worst cruel."(1)
To prevent the abuse of patients, furthering their confusion, or putting nurses and doctors at risk of ethical violations, parameters for therapeutic lying have been created.
Below is a list of some of the guidelines for therapeutic lying published in the International Journal of Geriatric Psychiatry:
Suggested Parameters for Therapeutic Lying(1)
1) Lies should be told only to benefit the patient, i.e., to relieve or avoid stress.
2) Covertly medicating patients or handling aggressive behavior require individualized policies documented in the care plan.
3) Caregivers should agree upon a clear definition of what constitutes a lie within each setting.
4) Patients' mental capacity should be assessed before the use of therapeutic lies.
5) Family consent should be sought prior to lying to a patient.
6) Once a lie has been agreed upon, it must be used consistently by all caregivers in all settings.
7) All lies told should be documented to ensure lies are being told in patients' best interests.
8) An individualized approach should be adopted with each patient — the relative costs and benefits established relating to the lie.
9) Circumstances in which lies should not be told need to be outlined and documented.
10) Lying should be in the best interest of the patient and should not demean, infantilize or disrespect her or him. The lies should be a vehicle for improving the patient’s well-being, rather than an infringement of their basic rights.
Ethical arguments against therapeutic lying assert that lying to patients infantilizes them and deprives them of human rights and personal autonomy. Opponents feel the freedom to make choices with a safe framework should always be a priority.
McElveen does not advocate therapeutic lying in situations where the patient is mentally competent enough to make decisions. Rather, therapeutic lying is beneficial in the advanced stages of dementia and Alzheimer’s when new information, such as the death of a loved one, is no longer retained and only causes further confusion and pain.
Reviewed May 17, 2016
by Michele Blacksberg RN
Edited by Jody Smith