open access
In defence of telling the truth to patients with dementia
Affiliations- Jagiellonian University Medical College Department of Philosophy and Medicine, Michałowskiego 12, 31-126 Kraków, Poland
open access
Abstract
In this bioethics’ paper, I oppose the arguments justifying lying and deceiving persons with dementia for
their good or out of compassion. The goals achieved by lying and deception should be achieved in other
ways. However, although in some extraordinary cases, a medical professional or caregiver can depart
from the veracity rule, this cannot lead to the invalidation of truth-telling, being a conditio sine qua non
of the respect for patient`s dignity. In addition, the consequentialist argument that says that a person
with dementia, while losing his or her discernment of the world, cannot be harmed when becoming the
addressee of a lie is wrong. I argue that accepting deception is not only paternalist and contradictory to
the principle of respect for patients but also harms the dignity of the caregiver community or care homes
institutions. If a dementia patient is not able to take care of his or her status as an adult and a person
worthy of respect, this task should be taken over all the more by caregivers. This is because dignity is
a social value, constituted in social interactions (shared dignity). Truthfulness is often a harder choice to
make, however, it should be given priority for the sake of human dignity, as well as for the authenticity
of the personal relations among those who provide care to the patient — at home or in a care home.
Avoiding the easier choice, which deception often is, requires an effort to build the communication skills
necessary to give bad news in the least harmful way possible.
Abstract
In this bioethics’ paper, I oppose the arguments justifying lying and deceiving persons with dementia for
their good or out of compassion. The goals achieved by lying and deception should be achieved in other
ways. However, although in some extraordinary cases, a medical professional or caregiver can depart
from the veracity rule, this cannot lead to the invalidation of truth-telling, being a conditio sine qua non
of the respect for patient`s dignity. In addition, the consequentialist argument that says that a person
with dementia, while losing his or her discernment of the world, cannot be harmed when becoming the
addressee of a lie is wrong. I argue that accepting deception is not only paternalist and contradictory to
the principle of respect for patients but also harms the dignity of the caregiver community or care homes
institutions. If a dementia patient is not able to take care of his or her status as an adult and a person
worthy of respect, this task should be taken over all the more by caregivers. This is because dignity is
a social value, constituted in social interactions (shared dignity). Truthfulness is often a harder choice to
make, however, it should be given priority for the sake of human dignity, as well as for the authenticity
of the personal relations among those who provide care to the patient — at home or in a care home.
Avoiding the easier choice, which deception often is, requires an effort to build the communication skills
necessary to give bad news in the least harmful way possible.
Keywords
dementia, truthfulness, authenticity, dignity, paternalism
About this articleTitle
In defence of telling the truth to patients with dementia
Journal
Palliative Medicine in Practice
Issue
Article type
Review paper
Pages
77-82
Published online
2021-12-30
Page views
4852
Article views/downloads
342
DOI
Bibliographic record
Palliat Med Pract 2022;16(1):77-82.
Keywords
dementia
truthfulness
authenticity
dignity
paternalism
Authors
Jan Hartman
References (13)- Schermer M. Nothing but the truth? On truth and deception in dementia care. Bioethics. 2007; 21(1): 13–22.
- de Boer ME, Hertogh CM, Dröes RM, et al. Suffering from dementia - the patient's perspective: a review of the literature. Int Psychogeriatr. 2007; 19(6): 1021–1039.
- Paterson R. Can we mandate compassion? Hastings Cent Rep. 2011; 41(2): 20–23.
- Jackson J. Telling the truth. J Med Ethics. 1991; 17(1): 5–9.
- Bakhurst D. On lying and deceiving. J Med Ethics. 1992; 18(2): 63–66.
- Dresser R. A Tangled Web: Deception in Everyday Dementia Care. J Law Med Ethics. 2021; 49(2): 257–262.
- Fields LM, Calvert JD. Informed consent procedures with cognitively impaired patients: A review of ethics and best practices. Psychiatry Clin Neurosci. 2015; 69(8): 462–471.
- Karlawish J. Creating the Truth with Persons Living with Advanced Dementia. J Law Med Ethics. 2021; 49(2): 266–268.
- Casey D, Lynch U, Murphy K, et al. Telling a 'good or white lie': The views of people living with dementia and their carers. Dementia (London). 2020; 19(8): 2582–2600.
- Cantone D, Attena F, Cerrone S, et al. Lying to patients with dementia: Attitudes versus behaviours in nurses. Nursing Ethics. 2017; 26(4): 984–992.
- Chalmers JM. Behavior management and communication strategies for dental professionals when caring for patients with dementia. Spec Care Dentist. 2000; 20(4): 147–154.
- Marzanski M. Would you like to know what is wrong with you? On telling the truth to patients with dementia. J Med Ethics. 2000; 26(2): 108–113.
- Weiner JS, Roth J. Avoiding iatrogenic harm to patient and family while discussing goals of care near the end of life. J Palliat Med. 2006; 9(2): 451–463.
