Therapeutic lying can be beneficial in dementia care but 'should be used as a last resort'

Care workers are often faced with a moral and ethical dilemma when they are caring for people with dementia - whether to tell the truth and cause them distress or deliberately deceive them with a ‘white’ lie.

The issue can arise when people living with dementia are convinced that their partner or a family member is still alive and wants to visit them.

Other problematic instances can be when the person with dementia becomes convinced that their partner is an imposter or deceiving them in some way or if they refuse to take their medication which prevents them becoming anxious and aggressive.

For care workers not wishing to see the person in distress by repeatedly telling them that person is dead, sometimes lying or agreeing with them can be a more preferable option.

Gary Mitchell, dementia care advisor for Four Seasons Health Care, speaking about the issue at the International Dementia Conference said: “It can be upsetting to see people you care about in distress, however lying or colluding with that person can be considered unethical.

“In some occasions people with dementia are told their medication is something like a sweet in order to keep them on their medication regime.

“It is a very contentious issue and some people think therapeutic lies are a slippery slope and they are not advocated in any laws.”

'Last option'

Mr Mitchell believes therapeutic lying should always be seen as a last option but concedes there are times when if the person’s health is at risk for example, it should definitely be considered.

When he first started out in his career in social care, he worked in a dementia unit, where there was a man who was always searching for someone and was continually walking around the unit.

“Because he used to walk around so much he would lose weight as he never sat down and wouldn’t eat and drink.

“They tried pharmacological intervention but the sedative calmed him down too much and he started having falls.

“Then one day I was by the dining room and one of the staff told the man who used to be in the RAF, that there was a phone call from the colonel and he needed to wait in the dining room to speak to him.

“He became confused as he was waiting for the phone call but he was being nourished and he was eating,” he revealed.

Lying to him had a beneficial impact on his health as it enabled him to eat and drink.

A recent report ‘Dementia – What is truth?’ by the Mental Health Foundation (MHF) written by Dr Yulia Kartalova-O’Doherty stated: ‘Such confusion or ‘delusions’ are usually complex and could be distressing not only for the person experiencing them but also for practitioners and carers who are supporting them. Knowing how to respond appropriately and helpfully is a constant challenge and at the heart of this is a debate around truth telling, distraction or lying’.

Therapeutic lying is pervasive

The MHF report found that therapeutic lying is pervasive and sometimes considered justifiable in dementia care.

Examples included not telling the person with dementia that their husband or wife was dead when they asked for them or colluding with delusions in order to lessen their distress and agitation.

There are no official guidelines on therapeutic lying by organisations such as the National Institute for Health and Care Excellence.

The Nursing and Midwifery Council advocates that nurses should ‘be open and honest, act with integrity and uphold the reputation of your profession’. They are told that failure to comply with the code can bring their fitness to practise into question and endanger their registration.

Similarly the General Medical Council states that doctors must ‘be honest and trustworthy in all their communication with patients and colleagues’.

Research carried out by Newcastle University and Northumberland Tyne and Wear NHS trust in 2013 found 98 per cent of nurses admitted telling therapeutic lies to patients and two-thirds of psychiatrists said they had done the same.

Lead researcher, Ian James, consultant clinical psychologist for Northumberland Tyne and Wear NHS Trusts said: "The skill of the nurse is to know when to use a therapeutic lie and to know why it is needed.” He added: "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.”

Alzheimer's Society does not support therapeutic lying

The Alzheimer’s Society is not in favour of health and social care professionals using ‘white lies’ for ethical reasons, with George McNamara, its head of policy saying: “The best approach to supporting someone with dementia should be person centred and flexible, taking into account someone’s unique history and using it to understand and acknowledge their present reality and their feelings. Knowing, observing and listening to the person allows a carer to see what a particular behaviour means – if they’re agitated they may be in pain for example”.

He added: “Good quality care should be about identifying and addressing their behaviour rather than encouraging people with dementia to live in a false reality. Techniques which advocate lying can be prescriptive and deception can be ethically dubious.

“Health and social care professionals need training to be able to confidently provide quality care to the 850,000 people living with dementia in the UK.”

People working in the care sector do seem to be agreed on one thing when it comes to this contentious issue and that is that the feelings of the person with dementia should be paramount.

However although therapeutic lying is seemingly a common practice among care workers, nurses and doctors, no official guidance means that healthcare professionals tend to be given no training or guidance in the use of ‘white’ lies and where there should be limits and what would be abuse of a very vulnerable person.

There is also the worry that clinical staff may end up using therapeutic lies for an easy life.

This contentious issue will not go away

Putting guidance or recommendations in place are seen by some as a ‘slippery slope’ but by others they are viewed as a way of regulating a culture of ‘white lies’ that seems to be endemic in caring for people with dementia.

This problem is not going to go away and will only get worse with the number of people with dementia set to rise, triggering an increase in the number of care workers who will have to deal with more and more cases of distressed and anxious people.