Reflective Practice in Dementia Care: The Therapeutic Lie

The concept of the therapeutic lie has been emerging in dementia care literature over the last decade. Succinctly, a therapeutic lie is told when it is deemed to be in a person’s best interest. Examples of what constitutes a therapeutic lie vary considerably in the literature. Naturally, the therapeutic lie has support (largely based on beneficence and the promotion of wellbeing) and opposition (on the grounds of deceit).
Using reflective practice, this presentation will provide case-study examples pertaining to the therapeutic lie in practice based on the literature and knowledge of professional experiences. Each case example has arisen in the clinical practice of healthcare professionals in dementia care. The scenarios that will be presented include: medication adherence, personal hygiene, doll therapy and management of distressed reactions. These case examples will be underpinned by theory around the activities of daily living model, bioethical principles, person-centered care and Kitwood’s philosophy.
Some healthcare professionals are calling for guidance around therapeutic lying as it is perceived as a means to remedy distress and enhance wellbeing. On the contrary, therapeutic lying can also be perceived as unethical and even undermine the personhood of the person living with dementia. While practitioners debate the ethical issues around the phenomenon healthcare professionals in practice are left confused about what is best practice in terms of the person with dementia, their professional registration and the law. Importantly this presentation offers no answers or recommendations, only an illumination of current practices.