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:
1) Lying to people with dementia: treacherous act or beneficial therapy? RCPsych.AC.UK. Retrieved May 16, 2016.
2) James IA et al (2006) Lying to people with dementia: developing ethical guidelines for care settings. International Journal of Geriatric Psychiatry; 21: 800-801.