Clinical Ethics and Therapeutic Lies: an opportunity for dialogue, education and harm minimisation.
Andrew Wheaton1, Metro South Health Woolloongabba 1Metro South Health, Woolloongabba, QLD, Australia
Abstract
“Where is my husband?” is usually a relatively easy question to answer. However, when the enquiry comes from a person with dementia, the appropriate response is not always ethically straightforward. In the instance where it is known that the husband has died, many healthcare professionals may use a ‘therapeutic lie’ to avoid telling a harmful truth, reduce agitation, and promote well-being for a person with dementia.
Beneficent intent notwithstanding, therapeutic lies represent a decoupling of practice from the requirements of honesty and integrity found in codes of ethics. Knowledge of these requirements can lead nursing staff to feel conflicted about therapeutic lies and fear punitive outcomes when observed lying. These concerns can limit open discussion of the potential value of therapeutic lies and consequently, staff may revert to potentially harmful truths when confronted with challenging questions. This can lead to distress for both people with dementia and staff. Relying on codes of ethics to guide practice appears to be insufficient and potentially inappropriate in this context.
This presentation suggests that clinical ethicists, in conjunction with relevant healthcare professionals, can play an important role in promoting professional and community dialogue regarding the acceptability of therapeutic lies and provide staff with relevant ethical guidance. The appropriate use of therapeutic lies requires ethical discernment and careful consideration beyond the scope of codes of ethics. With more than 400,000 people currently living with dementia in Australia, targeted education, open discussions, locally sensitive guidelines, and serious regard to public preferences concerning therapeutic lies require consideration.
Biography
Andrew Wheaton is the Metro South Health Clinical Ethics Coordinator. He is based in the Nursing Practice Development Unit at the Princess Alexandra Hospital. He has a clinical background as a Registered Nurse and attained a Master of Bioethics from Monash University.