What Are the Ethics of Fibbing in Dementia Care?

Friday, February 16, 2024

Caring for older adults with memory loss, particularly those diagnosed with conditions like Alzheimer’s disease or other forms of dementia, presents a unique set of challenges. As dementia family caregivers and healthcare professionals strive to provide the best possible care, ethical considerations often come into play. Therapeutic fibbing is a widely debated non-pharmacological approach to caring for those in various stages of memory loss.

Knowing how to balance honesty with managing some of the common symptoms that come with dementia is crucial for caregivers. As caregivers, our desire is always to be completely honest with our loved ones. Lying is wrong, right? Yet, in the situation of caring for an individual with dementia, truthfulness can at times lead to feelings of distress.

Understanding Therapeutic Fibs

Therapeutic fibs, when used from a position of kindness and love, involve telling a person with dementia a non-truth or a modified version of reality to spare a person undue pain or a recurring sense of loss. It can reduce distress, confusion, or anxiety. Therapeutic fibbing can even help to validate a loved one’s sense of self. The intent is not to deceive or manipulate but rather to provide comfort and maintain the individual’s emotional well-being.

For example:

  • If an older adult with dementia believes they are waiting for a loved one who has passed away, a therapeutic fib may involve redirecting their attention to a positive memory or suggesting that the person will arrive shortly.
  • If they believe they need to go to work, you can redirect their attention and begin to prepare lunch for their day or have them eat breakfast prior to leaving. This can often distract them from the desire to go to work.
  • If your loved one believes you are still a young child, talk to them about you from the past. Ask questions about what their child is like and who they look like, or ask them to tell you some of their favorite stories. This can be a great way to bond while living in your loved one’s reality.
  • If they believe they’re a chef, cook dinner together.

At its core, therapeutic fibbing encourages caregivers to focus less on facts and more on validating the person’s feelings and emotions during a time of confusion. Communicating within the person’s reality can promote contentment and decrease behavioral challenges that could result from being “corrected” about something.

The Ethical Dilemma

The use of therapeutic fibs raises ethical questions about honesty, autonomy, and respect for an individual’s dignity. In most cases, telling the truth is the reasonable, moral and ethical thing to do. When caring for a person in the middle or late stages of dementia, however, being rational and logical may actually cause problems for both you and your loved one, as they are no longer living in reality.

On one hand, proponents argue that the primary goal of caregiving is to enhance the quality of life for the older adult, and if a small deviation from the truth achieves that end, it can be considered justified – not lying. A lie requires intent to be deceitful or misleading, and those who utilize therapeutic ‘fiblets’ feel that the intention is what matters; the purpose is not to create false beliefs but rather to promote the well-being of a loved one.

On the other hand, critics emphasize the importance of respecting an individual’s autonomy and the potential negative consequences of perpetuating untruths.

Balancing Truth and Compassion

The ethical considerations surrounding therapeutic fibs highlight the need for a nuanced approach that prioritizes both truthfulness and compassion. Here are some key principles to guide caregivers and care professionals:

An Individualized Approach

Recognize that each person is unique, and what works for one individual may not be appropriate for another. Tailor the approach to the specific needs, values, and preferences of the older adult.

Open Communication with Families

Maintain open and transparent communication with family members or legal representatives of the individual with memory loss. Informed consent and shared decision-making are crucial elements in ethical caregiving.

Regular Reassessment

Continually reassess the situation and adapt your approach as the person’s condition evolves. What may have been appropriate at one stage of the illness may need modification over time.

Dignity and Respect

Always prioritize the dignity and respect of the older adult. Even when using therapeutic fibs, ensure that the communication is delivered with kindness, empathy, emotional sincerity, and a genuine concern for the person’s well-being.

The struggle with the choice of being positive but dishonest or candid but disheartening is a difficult one. Perhaps, though, honesty in this case comes in the form of emotional sincerity by responding to a loved one’s reality with compassion and empathy.

We’re Here for You

Learning the most effective ways to communicate with a loved one with dementia is important, but so is a safe place for them to call home. Bridges by EPOCH is here for families seeking memory care for a loved one. Contact the community nearest you to learn more.

Enhancing Quality of Life

Bridges® by EPOCH memory care communities have been developed from the ground up to anticipate, meet, and exceed the needs of our residents and their families. Our team of remarkable people, the exceptional care and services we offer, and the purposeful design of our buildings all combine to create the most rewarding, secure, and nurturing lifestyle possible for our residents.

Bridges® by EPOCH communities are located in Connecticut, Massachusetts, and New Hampshire, in the following towns: Norwalk, CT; Stamford, CT; Trumbull, CT; Andover, MA; Hingham, MA; Lexington, MA; Mashpee, MA; Pembroke, MA; Sudbury, MA; Westford, MA; Westwood, MA; and Nashua, NH.

Learn More About Bridges®

This field is for validation purposes and should be left unchanged.