Little white lies not always OK with people who have dementia

By • Published: February 15th, 2012
Category: Health in a Heartbeat

Little Johnny is outside playing with his friends. At least, that’s what his mother thinks. In reality, Johnny died 10 years ago at age 50 in a horrifying car crash. But for his mother, who has dementia, word of his death is news every time she hears it. And the emotional wound is just as fresh and deep each time. To ease that recurring pain, when Johnny’s mother asks for him, her caregiver just says he’s outside.

What’s a little white lie in that situation? Well, it’s a thorny ethical issue that has captured the attention of researchers, health care professionals, caregivers and patients. Care providers and patients agree that lying can be OK if it is in the patient’s best interest, but not if it’s just to get that patient to do something someone else wants him or her to do.

But when is lying in the patient’s best interest?

In new findings in the journal Aging and Mental Health, people who have dementia said that lying was patronizing and demeaning and robbed them of free will. They felt that a lie was unacceptable if the truth might later come to light, because it could lead to anger, distress and distrust. On the other hand, they said that if dementia was so advanced that a patient no longer had awareness of lies, then lying would be acceptable.

Caregivers and health care providers report being generally averse to giving false information. But they might be OK with deceiving someone with dementia without telling an outright lie — like withholding key details, going along with misconceptions or playing tricks. For them, lying is an option when the cost of telling the truth is high and the benefit small, such as when a patient is at risk of injury.

Who knows, even George Washington might have considered his stance on lying if he were a caregiver for people who have dementia.