Should you lie or tell the truth to your parent with dementia?

I was on a 4-day cruise to the Bahamas with my Mom and my best friend Theresa. We had all just enjoyed the sail away party on the upper deck. The cruise ship was smoothly sailing away to calm seas. Later, as Mom settled in the cabin on our first night, she asked if she was in the hotel. I answered: “No mom we’re on the boat”. “Oh? Ok but we’re not moving” she said somewhat confused. I replied: “Yes we’re moving…you just can’t feel it.” A few minutes later, “Are we in the hotel?” My friend and I responded with the truth, “No, we’re on the boat”.  “Oh, umm, ok” this time with a more a pained and puzzled look. After the seventh (or eighth) round, Mom repeated her question: “Are we in the hotel?” By this time (feeling tired and frustrated), Theresa and I chimed in unison and lied: ”YES! You are in the hotel”. Clearly relieved, Mom smugly smiled and with confidence said “Huh, I thought so!” She finally went off to sleep.

So, is lying to your parent with dementia okay? Or is it best to tell them the truth? Always?

The ethical dilemma: truth or lies

There are valid arguments on both sides of this issue. It is an ethical dilemma often faced by adult children when their parent asks questions that may leave them unsure about whether to answer honestly. Each situation should be dealt with on a case by case basis with a plan that best suits the timing and circumstances of a discussion.

If you are taking care of a parent who always stressed the importance of telling the truth, lying can be difficult and you may feel guilty even thinking about lying. Alzheimer’s Society U.K. offers advice on how to deal with the difficult dilemma of whether to (always) tell the truth to people with dementia.

In some cases, you may decide that not telling the truth is in the person’s best interests. If you do feel that the truth would be too unsettling for your parent, there are other approaches and options to consider.

Moving through the ethical dilemma

• Explore the feelings behind the question. For example, if Mom is asking for her mother, who is no longer alive, it may be that she is feeling scared or needs comforting. By not arguing with Mom or correcting her over the facts, it can be possible to offer emotional support to meet her need and bypass the question and need for an answer.
• Stretch the truth – it may possible to communicate with your parent without telling the truth or lying. For example, if your parent asks where their mother is, rather than explaining that they have died, you could reply with ‘Don’t worry, your Mom is safe’
• Distract the person. For example, if a parent repeatedly asks about a deceased relative or childhood friend, you distract them by redirecting the conversation, engaging them in an activity or game or move to a different room or location to chat. You could also ask questions like ‘Your friend? Tell me about her’. This allows your parent to talk about the person and express their feelings.
• Lie – this should only be done as a last resort when other options are not appropriate. A creative communication term used for lying is therapeutic lying or fibbing (or telling noble or comfort lies).

The idea here is that therapeutic fibs can benefit the caregiver and person with dementia by reducing stress. The motive for fibbing is seen as comforting your parent and sparing them unnecessary distress. When placed in this context, your motive to “lie” is an act of kindness rather than one of deception.

Take the cruise ship scenario. When I lied to my Mom that she was in a hotel and not on the cruise ship, she instantly became more relaxed and less distressed. Answering her honestly left things unresolved. Validating her reality that she was in a hotel comforted her. My friend and I were also less stressed as Mom no longer repeated the same question. Ultimately everyone had a greater peace of mind.

Things to think about around truth telling:

• Is your parent able to understand what they are being told? Are there ways of making it easier for them to understand?
• Are there ways of telling the truth that would be less upsetting for your parent?
• Would knowing the truth cause your parent more distress?
• Will lying make things more complicated in the long run?
• Is there a message behind the question that conveys an emotion or unmet need, e.g. fear, sadness, loneliness or disorientation?

When all is said and done, it is best to be mindful about your responses to your parent’s questions. Frankly, the fact that you are even asking yourself the question about whether to lie or tell the truth shows how conscientious you are about doing no harm.

This blog is about the ethical dilemma you may face if your parent has dementia. Have your experienced this or any other ethical dilemmas as you care for your aging parents? Tell us about it in the comments below.