Dementia and “Little White Lies”

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Little White Lies

Dementia is more and more on the minds of the American public as the “baby boomer” generation ages, raising the numbers of Americans afflicted with this significant decline in cognitive function. Dementia looks different for everyone, but it can result in personality changes, memory loss, mood swings, and general confusion. These symptoms bring up an interesting conundrum for caregivers: should they lie (small lies, of course) in order to calm upset loved ones who suffer from dementia and memory loss?

The Problem

Those with dementia often struggle with orientation toward time. Nor do logic and reasoning always sit well with a person who is not always rational. Kara Vanderpool Ward recommends rational lying–the telling of little white lies in order to preserve a loved one’s health, emotional wellbeing, or mood. Ward uses the example of her loved one insisting that income taxes be completed around Halloween. Ward pretends to file the forms online, spending time on the computer conspicuously in order to keep her loved one from feeling distress. Her argument is that aging loved ones do not necessarily need every piece of information and may not be able to properly process accurate information rationally, so the lie keeps everyone calmer and less stressed.

…respectful caregiving suggests that it may be easier to say that the car is in need of repair and thus cannot be driven.

This sort of harmless untruthfulness is often used by caregivers of people with dementia. Because dementia patients have trouble comprehending, for example, that they have poor driving skills as a result of dementia, it can become a hassle (and emotionally upsetting) to explain that they cannot use the car. Instead, an aticle at A Place for Mom about respectful caregiving suggests that it may be easier to say that the car is in need of repair and thus cannot be driven. Then there is no argument over who is well enough or not well enough to drive. Many dementia patients become combative over issues of ability, as they do not remember being sick and are trying to rationalize what their brains cannot fathom.

The Debate

The argument comes down to this: lying is wrong ethically. Those on the side of vigilant truthfulness warn against infantilizing dementia patients or taking away their dignity by “paternally” or “maternally” telling them lies. Respecting their autonomy and personhood should come first. Any good human relationship requires the trust that comes from truth-telling.

Yet telling inconsequential lies to someone who struggles cognitively may in fact be kinder (and thus more ethical) than attempting to always explain or fulfill the requests of an irrational person. Dr. Jeremy Gallegos quotes the first principle of the Hippocratic Oath for doctors: Do No Harm. If telling the unvarnished truth will upset or harm the dementia patient (the exception is in matters of diagnosis), there is nothing wrong with “therapeutic lying,” as the Family Caregiver Alliance calls it.

Therapeutic lying in cases like this reduces stress for both caregiver and the one cared for.

The Family Caregiver Alliance maintains that people with dementia do not need to be apprised of every unpleasant reality. They cite examples such as reminding an aging loved one that the person’s mother has died when the loved one begins to speak as if her mother is still alive. Insisting that her mother is dead brings more pain and a fresh sense of loss to the irrational person, who has forgotten such painful realities. Therapeutic lying in cases like this reduces stress for both caregiver and the one cared for. Little white lies can help caregivers cover their charges’ health care needs, soothe their stress, and make everyday activities simpler to complete. The pro “white lie” camp argues that caregivers put forth enough effort emotionally and physically; they do not need to spend time trying to navigate ethical gray areas.

In Summary

If a caregiver is clearly trying to avoid harm to a person living with dementia and to make the caregiving job slightly easier, he or she can rest assured that most people would make the same decision to tell little white lies. There are compelling ethical reasons for doing so. For those just beginning to care for their aging loved ones with dementia, therapeutic lying is a tool that may prevent emotional episodes and save time wasted explaining reality to someone whose brain cannot comprehend it.

 

Sources

APlaceforMom.com (April 29, 2015). Dementia Patients & Dignity: Respectful Caregiving. Available at http://www.aplaceformom.com/senior-care-resources/articles/dementia-dignity. Retrieved 1/15/2016.

Ward, Kara Vanderpool. (May 9, 2014). Caregiver, Caregiving, and Rational Lying. Getting Balance.com. Available at http://gettingbalance.com/care-giver-care-giving-and-rational-lying/. Retrieved 1/15/2016.

Gallegos, Jeremay A. (January 2015). “The Ethics of Truth Telling to Dementia Patients.” Journal of Health and Human Experience 1(1):55. Excerpt available at

Alz.org, http://www.alz.org/centralandwesternkansas/documents/Ethics.pdf. Retrieved 1/15/2016.

The Family Caregiver Alliance. Ten Real-Life Strategies for Dementia Caregivers. Available at https://www.caregiver.org/ten-real-life-strategies-dementia-caregiving. Retrieved 1/15/2016.