Dementia Care Series: Is it okay to lie to someone with dementia?
Several years ago I was giving a dementia education talk at a large assisted living community. During the Q & A, a daughter posed a question about her mom, a resident in the memory care unit. The daughter’s father passed away a few years ago but sadly her mother kept asking about where her dad was and when he was coming home. The director of this facility had advised the daughter to continually remind her mother that her spouse had passed away and even went as far as to suggest putting the father's obituary on the bulletin board in her room. The director coined this “reality therapy”. Was the director correct in their approach? Would it have been better to lie to the mother about the status of her husband?
Dementia is a progressive condition and over time, an individual with dementia will lose not only their memory but also their capacity to exercise reasoning and logic and make decisions about their care and life. This in turn can bring about very challenging situations where the individual may engage in behaviors that put their safety and well-being at risk. In the situation above, every time the daughter informed her mother that her dad had died, her mother would become very upset and traumatized. There are other countless scenarios I have encountered with patients including forgetting that they are not supposed to drive, lacking the insight that they cannot manage their finances and are being exploited, or continuing to believe that they can live alone, to name a few examples. When a situation like this occurs, is it okay to lie in order to safeguard their well-being?
The approach to fib or lie to a patient with dementia in order to protect not only their safety and well-being but also their dignity and sense of autonomy is called “therapeutic deception” or “therapeutic lying”. This practice is not without controversy as some believe that lying to an individual with dementia is amoral and unethical.
In the scenario at the beginning of this article, I advised the daughter that I felt it was best to not continually remind her mom that her dad had died. Instead, I recommended telling her mom that dad was away. It turns out that dad was an avid fisherman and it was not unusual for him to take frequent fishing trips. I recommended that this would now become the story and new reality for her mom and to then also use that as an opportunity to bring up favorite memories of dad about past family outings and fishing trips.
Therapeutic lying can be an effective tool and intervention for individuals with dementia. When it is deployed in a compassionate manner and with the sole purpose of protecting an individual's well-being and dignity, therapeutic lying can be an appropriate intervention to ensure that the individual is receiving appropriate care while also lessening stress and agitation.*
*It is important to note that this strategy should generally be used in individuals with rather progressed dementia where their level of understanding and insight limits their ability to ascertain that they might be being deceived.
