Imagine visiting your grandmother with dementia in a nursing facility. She asks you when her late husband will return. She appears distraught and confused about his absence. You see her looking at the door and she asks you if he came with you to visit her. What do you do? Would you tell her the truth that her husband has died? Or would you lie to her?
Situations that require moral decision making are relevant to many individuals who have a close family member with dementia. Relatives confronted with these situations struggle with difficult moral dilemmas, as different motives are pitted against each other. For instance, do you tell your grandmother the truth because it’s the right thing to do, or do you lie to spare her distress? Do you lie to make interactions and caretaking easier, or do you tell the truth because lying (and being discovered) could damage your relationship with your grandmother? These questions and the reasoning behind such decisions drove us to explore the morality of lying in our new article ‘Lying as a moral choice: An examination of moral reasons for lying in dementia relationships’.
Our research sought to examine why a relative of a person with dementia would choose either to tell the truth or to deceive when placed in a moral dilemma. Specifically, we asked young adult relatives to read and respond to brief vignettes covering topics including medication adherence (hiding medication in food, if the relative with dementia is refusing to take it), mobility (telling a relative that their car is getting repaired to prevent them from driving) and living situations (avoiding telling your loved one they are not returning home, but instead remaining in a nursing home).
Our research found four types of reasons for lying or not lying to a family member with dementia:
- First, we found a prevalence of caring reasons as participants often considered the welfare of the person with dementia, including protecting their physical and psychological wellbeing, when making moral decisions about lying/not lying.
- Second, justice reasons were observed, as participants also considered universal rules or principles such as ‘lying is always wrong’.
- A third reason included ‘care-for-others’ reasoning, which involved participants’ consideration for the welfare of others, such as nursing staff or other family members.
- Lastly, we observed relationship reasons consisting of considerations of whether lying or not lying to a family member with dementia would affect their current relationship.
Among the four reasons observed in our study, care reasons were the most frequent and predicted influences on decisions to lie. This finding was interesting to us because it appears the reason for choosing to lie stems from an altruistic and caring perspective, essentially motivated by a goal of protecting the welfare of one’s relative and/or decreasing their anxiety and distress. Furthermore, we found another altruistic reason for lying – protecting the welfare of the carer – as ‘care-for-others’ reasoning also affected the decision to lie.
On the other hand, the more participants considered justice-based reasons, the more they thought lying was wrong. Notably, the more relationship-based reasons participants reported, the more they thought lying was wrong – participants would avoid lying for fear of its harming their relationship with their relative. Importantly, it is not a solitary justification that can explain the moral reasoning behind a person’s decision to lie or tell the truth; rather, multiple moral reasons may work in concert, highlighting the complexity of decision making within dementia care.
The question then becomes: should you lie to your family member with dementia? Based on our findings, when lying and deception are employed by close family members, it appears that an altruistic care-based approach is prevalent. However, we encourage anyone who has a family member with dementia to reflect on the motivation behind your decision to lie or not lie, and on how the decision will ultimately affect the welfare of the person with dementia, other family members, your relationship with the person, and yourself – your own wellbeing and comfort with the decision.
We urge experts and policy makers to consider not only the wellbeing of the person with dementia but also that of both familial and professional caretakers. Initiatives that seek to support communities and society at large may be helpful in improving caregiver education and patient wellbeing as well as supporting family members who provide care to those with dementia (in the form of respite services, coping strategies and self-advocacy opportunities). Moreover, having knowledge about the prevalence and reasons for lying within a care-based approach may help reduce stigma and guilt, and alleviate the emotional burden on caregivers.
We hope that our article sheds light on the morality of lying, while also sparking curiosity and critical thinking regarding its broader implications. We encourage future efforts to further investigate the reasoning and consequences of a family member’s decision to lie or tell the truth as a function of the type of reasoning used. With the predicted exponential increase in the number of people with dementia (55 million current cases worldwide, with 10 million cases added each year), issues related to the morality of lying should be integrated into the standard of care for both those with dementia and their caregivers.
Amy E. Hodel is a registered occupational therapist licensed in the state of Indiana. Sarah Barron is a Licensed Professional Counselor in-training. Anca M. Miron is a Professor of Psychology at the University of Wisconsin Oshkosh
Lying as a moral choice: an examination of moral reasons for lying in dementia relationships by Amy E. Hodel, Sarah E. Barron, and Anca M. Miron. Available on Bristol University Press Digital.
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