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Medical Forum / Diseases and Disorders / Alzheimer's / April 2006Anyone read this weeks NYTimes ethicist column?
The topic of this week's column was whether it was unethical to use "therapeutic lying" instead of telling the elderly infirm the truth. The columnist said that deliberately misleading the patient robs them of their dignity. It was obvious from his reply that his personal experience with being a caregiver was all theoretical and not based on real life experince. Here is a copy of my response to his column and a link to the original column which should remain available online for a week or so. http://tinyurl.com/jnuh3 re: lying to infirm elderly robs their dignity To: ethicist@nytimes.com Mr Cohen, After reading your most recent column I can only believe your comments are those of someone who has never spent endless hours caring for an infirm and aged relative on a 24/7 basis. A elderly person who doesn't have dementia knows their limitations and won't ask to do the impossible. However the elderly and infirm person with some level of dementia might make all types of claims and requests. If you explain to them rationally why their request isn't going to happen, one of two things will likely happen - they will again ask you the exact same question you just explained to them or they'll want the horrid person calling them a cripple to leave them alone and not come back because they'll just keep taking care of themselves. In certain situations the caregiver isn't lying to them by telling loving deceptions. You are comforting them, since even a glimpse of the ugly truth will often be very painful to the infirm person whose requests can never be satisfied. They may not can remember what is wrong with them, but they will definitely remember that you were hurtful to them. Your opinion might be correct in theory, but in the real world it is both cruel and unworkable. Kind fibs go much farther in doing real good for the elderly infirm than do cruel and hurtful truths. 24/7 caregiver of many years best to all, AW I would only agree with the ethicist's viewpoint if he were specifically talking about people with their cognitive abilities relatively intact. When someone has serious cognitive impairments, "truth" is a relative thing. After all, many of us as caregivers have been confronted by loved ones who sincerely believe we are imposters, have stolen their money, that long dead relatives are visiting daily, that people on TV can see them and talk to them etc. When someone cannot retain new information, telling them "the truth" may only serve to upset them again and again and again, as they have to be retold repeatedly that their wives are dead, that the family home was sold a decade back, or that they've lost their license. "Truth" also means little when the person can't understand what they are being told - can't follow an explanation, can't comprehend the implications of a situation or the information they are being told, let alone make any sort of informed or reasoned decision about ANYTHING, whether it be as small as what to eat, or as big as whether they need full time round the clock care. M. >I would only agree with the ethicist's viewpoint if he were >specifically talking about people with their cognitive abilities [quoted text clipped - 9 lines] >their wives are dead, that the family home was sold a decade back, or >that they've lost their license. For once, I can fully agree with that, Mary. However, I don't believe that to be the case for those with coherent speech and thinking capability. I fear the burdon of care can too often skew the truth. anthony shipley Run away with me; I can make you unhappy. > The topic of this week's column was whether it was unethical to use > "therapeutic lying" instead of telling the elderly infirm the truth. The [quoted text clipped - 35 lines] > > best to all, AW Well said. Whenever I could, I told my mother in law the truth. When it was absolutely necessary to do so I told her a loving deception. There were indeed times when it was necessary. I don't for a minute think that a compassionate deception is the same as a lie. Intention is everything.  SignatureBest Regards, Evelyn (to reply to me personally, remove 'sox') I agree with the article in the sense that lying to a person with full congitive abilities would cause great irritability. My Mother is an example of that. Her body was frail but her mind was good right to the end and she would have been really offended by untruths. I think the problem with the writer is that he is only addressing fully minded people and not even considering people with diminished capacity. So therefore the article was not done very well....you might say half done. > > The topic of this week's column was whether it was unethical to use > > "therapeutic lying" instead of telling the elderly infirm the truth. The [quoted text clipped - 48 lines] > Evelyn > (to reply to me personally, remove 'sox') >I agree with the article in the sense that lying to a person with full > congitive abilities would cause great irritability. My Mother is an [quoted text clipped - 5 lines] > considering people with diminished capacity. So therefore the article was > not done very well....you might say half done. Oh yes, absolutely a critical distinction! If the person is infirm. frail, physically disabled, etc. but their mental faculty is fully in-tact (or mostly in-tact), they deserve to be dealt w/ honestly and to participate in making choices for one's self. It would be unethical to use deception and to hide the truth from such a person, no matter how tempting it might be at times for expediency sake. But a person w/ diminished mental capacity is a different story. ~katelyn~ > The topic of this week's column was whether it was unethical to use > "therapeutic lying" instead of telling the elderly infirm the truth. The [quoted text clipped - 3 lines] > experince. Here is a copy of my response to his column and a link to the > original column which should remain available online for a week or so. <snip> I did not see the column to which you refer, august, but I agree w/ you 100% in what you say and in your assessment that the author is unlikely a person who has dealt w/ this issue in his or her personal life. Your reply is excellent and I applaud you speaking out. Anyone who has dealt w/ a person w/ AD soon learns that the "truth" has no meaning to someone who has lost the ability to reason, to remember and to process logically. There's no point or value in telling the afflicted person the truth at every turn. Most often, what you need to do is whatever is most expedient to get something done as easily as possible, or whatever is handy to provide a moment's comfort and reassurance to someone who is badly confused. If you need to get the AD person to go somewhere he or she doesn't want to go, the best thing to do is tell them whatever will work to trick them into complying for the moment so you can get the necessary task done. If the AD person says I want to visit...mom, dad, sister, whatever, someone long deceased...it would be plain cruel to "remind" him or her that person is dead. All it will do is upset him/her terribly, and he'll forget anyway and ask again before long. It's far more kind to say "Oh we can't go there right now...the weather is not good for traveling and they aren't home right now anyway. We'll stay here for now and maybe we can go tomorrow." W/ luck, that will satisfy the AD person for the moment (or longer if your'e lucky) and will comfort him for the time being. ~katelyn~ |
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