LOVING DECEPTION
Is it OK to tell an Alzheimer’s patient a white lie? Therapeutic fibbing can avoid upset
A reader dealing with the strains of a family member suffering from Alzheimer’s raised this interesting question: “Our father always stressed how important it was to tell the truth. Now he has dementia, and my brother says he’s been told it’s OK to tell white lies so as not to further agitate our father. This makes me really uncomfortable. How can we resolve this?” When a family member or friend begins to lose their memory and cognitive abilities because of dementia, it can be hard to know the best way to respond. What should you say, for instance, when the person with dementia repeatedly asks about a spouse or child who is no longer alive? How many times can you tell the truth and watch a loved one suffer the same loss again and again?
Which is worse: telling a lie, or the harsh truth? Therapeutic fibbing, is an effective yet controversial strategy, according to the Alzheimer’s Association. In a nutshell, it’s lying — or not correcting a misconception — to decrease agitation and anxiety in a person with Alzheimer’s or dementia.
Elaine Schreiber, 79, is one of those with Alzheimer’s. Her husband, Martin, is a former governor of Wisconsin and the author of My Two Elaines: Learning, Coping and Surviving as an Alzheimer’s Caregiver. He’s perhaps the best-known proponent of therapeutic fibbing. In a telephone interview, Schreiber, also 79, explains how he justifies this approach. “Elaine repeatedly asks, ‘How are my parents?’ Early on in her illness, I told her the cold truth, which is that both of them are dead. The shock on her face was so devastating because she worried that she might not have gone to the funerals or said goodbye.” Over time, (Elaine was diagnosed 14 years ago), Schreiber says he could clearly see the anxiety the truth provoked, which is why he started to fib.
Schreiber says there’s no benefit in repeatedly trying to correct loved ones and that a fib can actually draw the caregiver closer to the patient. “This is about the importance of joining the world of the person with Alzheimer’s,” he said.
Schreiber cites another related story. Not that many years ago, Schreiber says, Elaine told him matter-of-factly, “I’m beginning to love you more than my husband.” He didn’t correct her, nor did he ask about her “turkey” of a husband. “I just grabbed that moment of joy,” he said. Although doctors and medical ethicists are generally proponents of truth-telling, dementia experts tend to support these kinds of white lies — with certain caveats.
“For people who are cognitively impaired to a level where they cannot absorb or process information well enough to understand it, therapeutic fibbing is a way to avoid upsetting them in ways that serve no purpose,” said Amy D’Aprix, an aging and caregiving expert and a developer of the Home Instead Senior Care Alzheimer’s CARE Training Program.
But D’Aprix also cautions that caregivers must not justify telling a therapeutic fib in order to avoid difficult or painful conversations. “Once I was asked if a daughterin-law should tell her mother-inlaw, who had dementia, that her son had just died. I said, ‘Yes, she deserves to be told, once or maybe twice.’ That’s because the mom deserved the right to be sad or grieve even if she couldn’t retain the information. But more often than that simply feels cruel.” Jason Karlawish, co-director of the University of Pennsylvania Memory Center, prefers calling this approach “loving deception” and says whether or not to lie is about intent, reminding us that “the moral role of the caregiver is to respect the person’s sense of identity and self.”