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A resident asks every night when her husband is coming. Is going along with it a lie?

Elin Hedqvist Fellow
· 4 replies
Applied ethicsModern EuropeanCare ethicsImmanuel KantNel Noddings#care-ethics#dementia#honesty#lying
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Its coordinates: 3.3 Applied Ethics

Just off a night shift, so forgive the tired writing.

One of our residents, I'll call her Margit, is ninety-one and has advanced dementia. At about three every night she wakes and asks when her husband is coming to take her home. He died many years ago.

If we tell her that, she grieves as if for the first time. Every time. Some of my colleagues say, "He's working late, he'll come in the morning," and she settles and sleeps. Our training calls this "meeting her in her reality." I have done it myself, and each time it feels both kind and slightly wrong.

My Stoics don't help much here. Kant would forbid the lie, I think, whatever it costs her. But I'm not sure "he'll come in the morning" is a lie in the sense he meant, when she won't remember either answer by four o'clock.

So my questions:

  • Is it still a lie if the person cannot hold the truth?
  • Some nights I avoid both answers and ask her to tell me about him instead. Is that more honest, or just a more comfortable evasion?
  • Does it matter that she would have hated, when she was well, to be managed like this? I don't know whether she would have.
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4 answers

  1. Nadia Haddad

    Fellow

    On our palliative unit we are taught to answer the feeling, not the question. "You miss him." "Tell me what he was like." It is close to what you already do on your better nights, and I don't think it is an evasion.

    Nel Noddings says the first moment of caring is receptivity: taking in what the other person is actually going through. At three in the morning Margit isn't really asking for information about her husband's schedule. She is lonely and frightened in a strange room. Answering that is not a lie, and it may be the only truthful response available.

  2. Alistair Gow

    Fellow

    We argued about this for years in the surgery, usually about patients with dementia living at home with a spouse who kept "reminding" them.

    On Kant, I think you have him right. In the late essay on the supposed right to lie, he insists that the wrong of a lie is done to humanity in general, not only to the person deceived, so a kind motive doesn't rescue it. He would not be moved by her sleeping well.

    Hume would ask what the practice does. A rule of always correcting her produces a fresh bereavement every night for a woman who can't keep the comfort of having grieved. That looks less like honesty than like cruelty with a clear conscience.

  3. Bilal Rashid

    Fellow

    Al-Ghazālī has a passage in the Iḥyā', in the book on the dangers of the tongue, that I keep coming back to on hospital visits. Speech, he says, is a means to ends. If a good end can be reached by truth, lying to reach it is forbidden. If it can be reached only by an untruth, the untruth becomes permissible when the end is permissible, and necessary when the end is necessary.

    He keeps this narrow and warns against using it as an excuse. But Margit seems close to his case. The end, sparing her a nightly bereavement she cannot remember, can't be reached by the truth. I would still try Nadia's way first.

  4. Elin Hedqvist

    Fellow

    Thank you, all three. "Answer the feeling, not the question" is what I was groping for, and Bilal's order of preference helps: try the true comfort first, and keep the untrue one for when nothing else works.

    I'm on again tonight. I'll ask her what he used to bring home from work. She once told me it was smoked eel on Fridays.