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Mueller 86 The Wall Street Journal -- By Sue Shellenbarger 11/11/2004

Work and Sources for Therapeutic Lying Week 7 and 8 Works Cited

Shellenbarger,Sue. "Therapeutic Lying and Other Ways to Handle Patients with Dementia." Wall Street Journal.11 November 2004 18 November 2011 eldercare.infopop.cc.

Dementia can be a very frightening experience for those suffering with it, especially in the early stages of the the mental decline. It can be even more overwhelming when those you trust argue with you over everyday events. Many who care for those with dementia have found that telling a "white lie" to keep the family member or patient at peace is the answer to those who frequently become upset or agitated over the truth. It is a dignified way of touching their reality and often times, it is the only way to help those suffering from the often harsh and cruel reality of losing reality.

"There's a method to the madness. Researchers and counselors believe these new therapies can ease the caregivers' stress and help people with dementia, too. Among the methods: "therapeutic lying," or going along with elders in their confusion to avoid conflict; Aikido, a way of empathizing named for a non aggressive Japanese martial art; and "validation therapy," which entails joining patients in recalling buried memories and emotions.

The techniques aren't for everyone. Sometimes the tactics demand too much of caregivers, or they risk isolating or offending the patient. Nevertheless, a growing number of caregivers swear by the techniques.

All have one thing in common: They require the caregiver to give up trying to force the dementia patient to accept reality, and surrender instead to the fact that the patient is living in another mental and emotional world. They differ in the degree to which the caregiver tries to understand the feelings and needs that underlie the dementia patient's behavior.

With therapeutic lying, the caregiver briefly pretends the elder's illusions are true and tells a lie as a distraction. A caregiver might tell a relative who insists on seeing her dead sister: "She went to the store. She'll be back in a bit."

Therapeutic lying can be practical and effective in matters of no consequence. It's best used to smooth over a brief moment of confusion. It can help control and reassure a dementia patient when time is short. But there are risks; some patients will know subconsciously that the caregiver is lying. Remembering the truth later, they may confront and accuse the caregiver."

Source Number Two Waldman, Terri. "Therapeutic Lying." 26 November 2011. <www.azfid.org>.

In the presentation made by Terri Waldman, LMSW a clinician and Administrator from a mental health hospital in California she presents the audience with the ethical dilemma in therapeutic lying in which the clinician has an ethical duty "to an incapacitated or vulnerable adult; financial exploitation; civil and criminal penalties;exceptions;definitions…" "Why is this relevant to us? -We are the person in a “position of trust and confidence.” -We cannot deceive or create false impressions with our clients. -We cannot make promises that cannot be kept." (Waldman) While therapeutic lying may be easier on the person with dementia and the clinician caring for them at the moment, Waldman makes an excellent point that this type of deception may erode trust, especially if the person with organic brain syndrome has a moment of clarity.

Source Number Three

Lajeunesse, Richard C. "Therapeutic privilege: between the ethics of lying and the practice of truth." 28 November 2011.

    <www.ncbi,nlm.nih.gov>

This article poses the moral dilemma often encountered by physicians who have two sometimes conflicting obligations to a patient. Should a doctor lie to a patient to preserve hope and integrity and practice the art of therapeutic lying in order to preserve his commitment to beneficence? Or is the practitioner obligated to preserve the patient's autonomy and essentially the right to know, even if it is not in the best interest of the patient, and in essence may do more harm? The practice of lying therapeutically is a quagmire that will continue to require those in the health care industry to contemplate and make ethical decisions on a case by case basis. The right to autonomy and to be fully informed is a basic human right in the health care industry. Practitioners, especially doctors, take oaths to uphold this basic right. Conversely, practitioners take an oath of beneficence, to do "no harm" and to protect the patients basic psychological needs;compassion, integrity and security. If lying to that patient to preserve that right outweighs the patients right to autonomy, then the practice of therapeutic lying may be a necessary practice.