The slide into dementia is slow and painful, for those suffering directly and the loved ones on the periphery who must provide care while watching a trove of memories gradually erode. Patient care works inside this delicate balance, but going against the wishes of the Alzheimer’s Society, nearly all nurses in a recent survey reported telling the occasional white lie to avoid patient bereavement.
The ethics of such a practice are slippery. Memories keep people anchored in the shared reality of family members, friends, and even their conceptions of themselves. When a nurse is asked about a family member who has been dead for years, she must negotiate a thin moral line: Does she tell a small lie to pacify the patient, or tell a potentially devastating truth? What if the scenario takes place on a regular basis?
Questions like these motivated British National Health Service employees to investigate cases of “therapeutic lying” among nurses and psychiatrists, the findings of which were published in Nursing Standard.
Teams from Newcastle University and Northumberland Tyne and Wear NHS trust surveyed 112 nurses about their histories of lying to patients. Over half said they'd had doubts about lying’s ethics, and nearly all — a full 98 percent — said they had lied to a patient if they thought it was for the patient’s own good. Out of the 76 psychiatrists surveyed, 70 percent said they had told a therapeutic lie.
The Alzheimer’s Society discourages protocol that uses lying as a way to palliate dementia sufferers. Instead, nurses and psychiatrists should offer support so that patients do not “live in a false reality.”
"Good quality care should be about identifying and addressing these causes rather than encouraging people with dementia to live in a false reality," said George McNamara, Head of Policy at the Alzheimer's Society.
Nurses responded less than hopefully, as the trend among patients seemed overwhelmingly tilted toward questions of realness. Answering a patient truthfully about her fallen relative could be too harsh for her to handle, care experts told the Telegraph. But rather than lie, some nurses said they would simply avoid the truth.
"I can live with non-expression of the truth,” said one survey participant, “but not a blatant lie.”
The ethical line exists somewhere between maintaining patient autonomy and avoiding causing undue harm. When one patient “pestered” the nurses about catching a bus, he was told to sit outside and wait for an imaginary one, in order to keep him happy. McNamara urges healthcare practitioners to “give people with dementia choice and control over their life whenever possible.”
Dementia UK admiral nurse Dave Bell said nurses should maintain their own autonomy as well, making executive decisions when they see fit. Telling a lie may serve one case but not another, due to specific circumstances. Case-by-case decisions leave room for faulty discretion, but give nurses freedom to seek a better understanding of their patients.
"The skill of the nurse is to know when to use a therapeutic lie and to know why it is needed," said researcher Ian James, consultant clinical psychologist for Northumberland Tyne and Wear NHS Trust. "But the best thing to do is to distract the patient so the nurse does not get drawn into the ethical issue of telling a lie."