Deception in Dementia Care
Amara works in a dementia care home, where the patients are in various degrees of physical and cognitive decline. Some of them find it difficult to perform routine tasks, such as getting dressed and eating. Many have trouble remembering basic information, like what day of the week it is. They sometimes struggle to identify their closest family members.
Barry is a resident of the care home with severe memory problems. Almost every day, he asks Amara where his wife is, forgetting that she died many years ago. When Amara first started working with Barry she would tell him the truth. But learning that his wife had died was extremely upsetting for Barry, and Amara eventually began to wonder whether it might be kinder to spare him the pain of bereavement every day. So now when Barry asks, Amara tells him that his wife is out at work, or has gone to take their granddaughter to a soccer game. This doesn’t distress Barry, who soon forgets about his question.
Lying to patients with dementia is extremely widespread. As one author recently put it, “a recent survey found that close to a hundred per cent of care staff admitted to lying to patients, as did seventy per cent of doctors” [1]. Proponents of the practice argue that lying to patients keeps them calm and prevents suffering. It also makes things easier for staff, who might otherwise have to deal with distressed patients that can sometimes become violent.
But some think that lying to patients with dementia is inappropriate. They argue that telling patients the truth is the right thing to do even if it is disturbing or harmful for them. Wouldn’t you want to know about a loved one’s death, no matter how painful it might be? Lying in dementia care can also cause breakdowns in trust between patients and their caregivers. If different people give them contradictory information, the patients won’t know who to trust anymore.
Those who defend lying in dementia care argue that the diminished mental capacity of dementia patients justifies treating them in ways that it would not be permissible to treat competent adults. An analogy is drawn to childhood: just as it can be acceptable to lie to young children, who lack the capacity to decide for themselves what is best for them, so it can be acceptable to lie to those with dementia whose capacities are impaired.
DISCUSSION QUESTIONS
Why is honesty generally morally important in healthcare settings? To what extent are these moral issues applicable or inapplicable in a dementia care setting?
Are there circumstances in which we are morally required to lie to dementia patients?
Is it morally permissible for Amara not to tell Barry that his wife is dead? Why or why not?
References
[1] The New Yorker, “The Comforting Fictions of Dementia Care”
