Nothing but the truth? On truth and deception in dementia care

Bioethics

Volumn 21, Issue 1, 2007, Pages 13-22

  Schermer, Maartje ^a  

^a ERASMUS MEDICAL CENTER   (Netherlands)

Author keywords

Alzheimer's; Deception; Dementia care; Lying; Simulation; Truth telling

Indexed keywords

ARTICLE; DEMENTIA; EVALUATION; HUMAN; MEDICAL CARE; MEDICAL STAFF; MORALITY; NURSING STAFF; PATIENT CARE; RECUMBENCY; WELLBEING;

BIOETHICS; CAREGIVERS; DECEPTION; DEMENTIA; FEMALE; HUMANS;

EID: 33845629103     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2007.00519.x     Document Type: Article

References (25)

1. L. Camberg et al. 1999. SimPres: A Personalized Approach to Enhance Well-Being in Persons with Alzheimer's Disease. In Enhancing the Quality of Life in Advanced Dementia. L Volicer and L. Bloom-Charette, eds. Philadelphia: Taylor & Francis: 126-140.
2. L. Camberg et al. Evaluation of Simulated Presence: A Personalized Approach to Enhance Well-Being in Persons with Alzheimer's Disease. J Am Geriatr Soc 1999; 47: 451.
3. S. Bok. 1999 (originally 1978). Lying. New York: Vintage Books: 13.
4. J. Jackson. 2001. Truth, Trust and Medicine. London and New York: Routledge: 48.
5. B.J. Benjamin. 1999. Validation: A Communication Alternative. In Enhancing the Quality of Life in Advanced Dementia. L. Volicer & L. Bloom-Charette, eds. Philadelphia: Taylor & Francis: 107-125.
6. Bok, In Enhancing the Quality of Life in Advanced Dementia. op. cit. note 3, p. 206.
7. C.M. Korsgaard. 1996. Creating the Kingdom of Ends. Cambridge: Cambridge University Press: 140.
8. C.M. Korsgaard. Creating the Kingdom of Ends. Ibid: 335-361.
9. O. O'Neill. 2002. Autonomy and Trust in Bioethics. Cambridge: Cambridge University Press: 98.
10. However, it has also been argued that according to Kant some exceptions to the rule 'never to lie' are possible. A maxim allowing lying to deceivers, for instance, is universalizable. Korsgaard, Autonomy and Trust in Bioethics. op. cit. note 7, p. 137.
11. C. Hertogh et al. Truth Telling and Truthfulness in the Care for Patients with Advanced Dementia: an Ethnographic Study in Dutch Nursing Homes. Soc Sci Med 2004; 59: 1685-1693.
12. Camberg, Soc Sci Med op. cit. note 2.
13. In the following I will assume that demented people enjoy SimPres because they believe they are having a conversation with a relative. This may not be a correct assumption, however. Maybe people simply enjoy the familiar voice - just like religious music or songs from childhood can be soothing - without having any 'beliefs' about what is going on. If people enjoy SimPres not as a conversation but simple as an enjoyable stimulus, I do not see anything wrong with it. As mentioned earlier, it is not really deceptive in such cases.
14. R. Nozick. 1974. Anarchy, State and Utopia. New York: Basic Books: 42-45.
15. L.W. Sumner. 1996. Welfare, Happiness, and Ethics. Oxford: Oxford University Press: 96.
16. L.W. Sumner. Welfare, Happiness, and Ethics. Ibid: 159.
17. And according to some, also for nature. See R. Elliot. 1997. Faking Nature. The Ethics of Environmental Retoration. London and New York: Routledge.
18. It may not always be easy to make a sharp distinction between real and fake. Definitions of what 'real' interaction is, and of the value of interaction may change under the influence of new social or technological developments. For example, in robotics and human-computer interaction the boundaries seem to shift. People may interact with computers as if they were real people.
19. If we also count having meaningful (family) relationships as things that contribute to a good life, we should look how these fake conversations should be placed in the maintenance of the relationship as a whole. Is it a mere substitute, provided by family members who do not bother to come in person and see SimPres as an easy way out? Or is it a tool to help maintain and strengthen the relationship, keep memories awake, be virtually 'present' when one cannot always really be present? If SimPres fits in a good family relationship and helps to maintain or strengthen it, it may add to overall well-being.
20. B.A. Rich. Prospective Autonomy and Critical Interests: A Narrative Defense of the Moral Authority of Advance Directives. Camb Q Healthc Ethics 1997; 6: 143.
21. Volicer, Camb Q Healthc Ethics op. cit. note 1.
22. T. Yang-Lewis & R. Moody. The Forgetful Mourner. Hastings Cent Rep 1995; 25(1): 32-33
23. Bok, Hastings Cent Rep op. cit. note 3, p. xxii.
24. Jackson, Hastings Cent Rep op. cit. note 4.
25. There may of course be cases in which the 'own reality' of the demented patient is painful, and it would be a relief for him to know the truth and connect to reality. In such cases of course one should try to get the truth across in order to avoid pain.