Telling a ‘good or white lie’: The views of people living with dementia and their carers

Abstract

Objective: A common symptom of cognitive decline in people living with dementia, or people with memory problems, the cause of which has not yet been diagnosed, is the person repeatedly asking for loved ones who are deceased or making statements that are incorrect. Carers are then faced with a dilemma, do they avoid and distract or 'correct' the person and tell the 'truth', or tell a lie. This paper explores the concept of lying from the perspective of people living with dementia in the community and their informal/unpaid carers. Methods: A descriptive qualitative study utilising focus groups (FG) to collect the data was conducted. Three FG's with a purposive sample of people with memory problems (n = 14) and three FG's with informal/unpaid carers (n = 18) were undertaken. Qualitative content analysis was used to analyse the data. Results: All participants considered that blatant lying with the intention to deceive and do harm is not acceptable. However, telling a 'good lie' or 'white lie' to alleviate distress was in certain circumstances considered acceptable. The intention behind the 'lie' in their view had to be to do good, and the informal/unpaid carer telling the lie had to really 'know the person' and be cognisant of family preferences. Some informal/unpaid carers acknowledged that it may be acceptable for health care professionals to tell a 'good lie' or 'small lie' in certain circumstances. However, health professionals need to 'know the person' and need to consider informal/family caregivers' wishes. Conclusion: Lying was only considered acceptable in the context of knowing the person and when done with the intention not to harm or deceive, undertaken with empathy, and only for the purpose of mitigating the person living with dementia's distress.

Beyond the Medication Pass: Attitudes, Ethics, Agency, and Antipsychotic Medications in Assisted Living/Residential Care

“…Fear of regulatory noncompliance might lead staff to attempt too many behavioral interventions, prolonging a resident’s pain or distress or putting staff or other residents in harm’s way ( 57 ). Participants shared that doing what is best for the resident should drive decision-making, even if what is perceived as “best” includes elements of deception (eg, white lies) ( 58 ). However, resource constraints and organizational obstacles present significant barriers to the person-centered approach that is often required, and recommended as best practice ( 9 , 59 , 60 ).…”

The use of therapeutic untruths by learning disability nursing students

“…The use of therapeutic untruths has raised a number of complex ethical issues and there are conflicting views about their appropriateness and acceptability. On the one hand, therapeutic untruths are seen as unprofessional, immoral, a fundamental betrayal of trust, or a form of abuse by those who oppose their use, 5 , 6 although people with dementia themselves condone their use under certain circumstances, that together constitute an action that is in the best interests of the person. 6 , 7 On the other hand, therapeutic untruths are seen as a means of communication with people who have memory loss, a decline in functional ability and who may create their own reality, 8 or as a strategy to alleviate anxiety.…”

“…On the one hand, therapeutic untruths are seen as unprofessional, immoral, a fundamental betrayal of trust, or a form of abuse by those who oppose their use, 5 , 6 although people with dementia themselves condone their use under certain circumstances, that together constitute an action that is in the best interests of the person. 6 , 7 On the other hand, therapeutic untruths are seen as a means of communication with people who have memory loss, a decline in functional ability and who may create their own reality, 8 or as a strategy to alleviate anxiety. 9 Indeed, it has been suggested that the ethical principal of beneficence and preventing harm to others may well be interpreted in some situations as requiring the professional to use therapeutic untruths.…”

“… 9 Healthcare professionals, therefore, face a dilemma in relation to the use of therapeutic untruths and must consider the legal, ethical and clinical issues when making decisions about this practice. 6 , 10 This means that the extent to which therapeutic untruths are used may be influenced by the ethical stance that staff adopt in relation to therapeutic untruths and the associated moral discomfort if they use them in practice.…”

Is it ever ethical for nurses to lie to patients?

“…Casey et al's study also highlighted motivation as a key element of telling a 'good lie'. 3 As new emerging research contributes to the debate about lie telling, it may be that nurses caring for people with dementia should no longer ask themselves 'should I lie?' but rather 'if I must lie, how can I be genuine in my interaction, and what is my motivation?…”