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Truth Telling, Deceit and Lying in Cases of Advanced Dementia
  1. Rob George
  1. Rob George is Professor of Palliative Care, Cicely Saunders Institute, King’s College London, School of Medicine, and Consultant in Palliative Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London. Email: rob.george{at}kcl.ac.uk

Abstract

Telling the truth is an integral part of every relationship. If people are not told the truth, it is hard for them to function effectively in society. In health care, if clinicians lie to patients, then patients are unable to make informed decisions. Such practice compromises patients’ autonomy. Therefore, the prevailing view in health care is that clinicians should be truthful at all times and are obliged to provide full and honest disclosure. However, there may be exceptions to that general rule. This article is the first in a regular series of ethical discussions relating to palliative and end-of-life care. It explores the principle of truth telling in relation to an 80-year-old woman, Martha, with advanced, multi-infarct dementia. When Martha suffers further infarcts, her cognitive ability temporarily worsens. Martha’s fluctuating level of cognitive ability means that other people have to make best-interest decisions on her behalf. However, there is conflict within her family as to what are in Martha’s best interests. This article examines whether it is always in patients’ best interests to be told the truth and whether situations exist where lying may be justified. Conflicts of interest: none

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