Can Lying Be Ethical?

Sometimes a lie can be forgiven. In fact, sometimes a lie is necessary. This week we'll hear from a listener wondering whether it's ethical to lie in order to reassure an elderly dementia patient.

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DEBBIE ELLIOTT, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Debbie Elliott.

As lifespans get longer, more and more people end up caring for their aging relatives, an experience which can sometimes be heartbreaking. This week's letter for ethicist Randy Cohen comes from a listener who's elderly father-in-law suffered from Alzheimer's.

Martin Dykeman(ph) joins us on the line now from Waynesville, North Carolina.

Hello there.

Mr. MARTIN DYKEMEN (Caller): Hi. How are you?

ELLIOTT: Good. And Randy, are you with us again? Hello?

Mr. RANDY COHEN (Ethicist): Hi, Debbie.

ELLIOTT: Mr. Dykeman, I'm sorry to hear that your father-in-law recently passed away.

Mr. DYKEMAN: Yes. And it wasn't too long ago.

ELLIOTT: Now, you told us that your father-in-law would get very upset when you would visit him. Explain to us what the problem was.

Mr. DYKEMAN: The problem was that he would be very emotional when we arrived, and then when it came time to leave, he would be emotional again. He would not want us to leave. He would cling. He would cry. And he would have to be restrained, in fact, by the staff where he was living.

ELLIOTT: And did you feel there was anything you could do to calm him down?

Mr. DYKEMAN: Well, it occurred to me on one of the last visits when we were able to tell him that we would be back the next day, and that was true, we were going to be back the next day, that he was very peaceful when we left. He seemed to accept that. And it gave me the idea of wondering whether this would be an ethical thing to do on occasions when we did not intend to be back the next day.

ELLIOTT: Now, I would think that the nurses in your father-in-law's nursing home have dealt with this kind of problem before. Did they have any advice for you?

Mr. DYKEMAN: We did not raise that question with her, but I did raise it with a former intensive care nurse who happens to be the cantor at our congregation in Asheville, and knowing that she could approach it from both a religious and a medical perspective, I asked her the same question. She said she didn't regard it as an ethical question as much as a practical one. Nine times out of 10, she said, the person who's suffering from dementia will not remember what you told him or her the day before, sometimes even the hour before.

But they come and they go and on occasion there will be an occasion when their memory of the previous day or the previous hour will be very clear and then they will know that you made a promise you didn't keep. And she had left us with that thought. We never got to try it out because he became very ill and died soon after.

ELLIOTT: Randy, what's the right thing to do in this situation?

Mr. COHEN: Well, you know, Mr. Dykeman is right, that many people do have this concern. I've received many variations on this question at the column and as a result, I've spoken to several physicians about it.

I've come to the conclusion that throughout the column - for other questions, too - that there are many times when a lie is absolutely justified.

And two guidelines I find helpful is when you're attempting to benefit another person rather than yourself, and when there's no other way to achieve that end - and sadly, I believe the situation with an Alzheimer's sufferer sometimes meets that test.

So if a person is no longer lucid and there's no other way to reassure them, I believe it's utterly justified. In fact, it's more than justified. It's admirable. It's an act of true kindness.

ELLIOTT: Now, wouldn't there be the risk that that one time in 10, when the patient was lucid and you lied and they realized it, that that could cause harm?

Mr. COHEN: Yes. There's absolutely that risk, but to choose the most ethical solution, we have to look for the most beneficial results. An ethical solution doesn't have to be utterly perfect. Clinging to, I think, what in this case is a false idea of modesty, is going to produce horrible distress and suffering 90 percent of the time. And while there is some risk involved, it's a risk worth taking.

ELLIOTT: Mr. Dykeman?

Mr. DYKEMAN: Well, I'm pleased to hear that because I think that's going to help a lot of other people. We asked friends and associates if they had this problem, and they said, oh yes, in fact we were told that many people are hesitant to visit their relatives because they simply can't cope with it.

ELLIOTT: Martin Dykeman, thank you for writing to the ethicist.

Mr. DYKEMAN: And thank you for answering.

ELLIOTT: If you'd like advice from Randy Cohen, please do write to us. Go to our Web site, NPR.org. Click on Contact Us and select WEEKEND ALL THINGS CONSIDERED. Put the word ethics in the subject line and don't forget to include a phone number where we can reach you.

Randy, thanks as always.

Mr. COHEN: Thank you, Debbie.

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