Sacca pāramī : truthfulness, honesty
In the last post, we looked at probably the most dramatic instance of a medical lie, one which involves the diagnosis of a fatal illness. It is (we hope) less common now than it was several generations ago for a doctor to intentionally mislead a patient, but let’s consider a situation that is less straightforward. What if the patient has a limited capacity to understand what a doctor (or anyone) is talking about?
There are two special cases that come to mind: aging relatives with dementia, and loved ones of any age with a mental illness.
A dear friend of mine cared for both an aunt and her mother for twenty years while they deteriorated from Alzheimer’s disease. She spoke of the ethical crisis of being asked over and over again (within minutes), “When can I go home?”. Through trial and error, my friend discovered different responses that suited different stages of understanding. Some possibilities are: “When you’re feeling better”, “Soon”, or “When the doctor says it’s time”. Her main goal was to find a response that would soothe her agitated relative and be truthful at the same time.
Dementias are not all the same, and a person can be perfectly lucid one moment and have no idea where they are the next. Being truthful in this situation can be a real challenge. Sometimes it may be best to say “I don’t know” or “I’m not sure what you’re asking/saying”. At some stages, clarifying questions may be helpful. If the person with dementia is frustrated, they may take it out on you – still no reason to make things up. In this territory, there is no clear guide except to avoid an outright lie.
A similarly complicated situation is when a loved one has a mental illness. This relationship is even more unpredictable, and locating the ethical capital within it is crucial. When someone we care about has a distorted view of the world, themselves, or a situation, we naturally want to help them see more clearly. However, this is often not possible if the illness is serious and the agitation level is high. In general, we want to provide a reliable mirror of reality for our dear one to come back to. But I’ve been told (and witnessed) that gentleness is a non-negotiable requirement. Lower the temperature, speak in soft tones, don’t take the agitated person’s words literally or personally. It doesn’t always help, but it can’t hurt. Don’t try to manage the situation, except to keep everyone safe and allow the intensity to decrease and the breathing to slow down. Sometimes, there’s nothing for it but to get the person to a professional or an emergency room.
Chronic mental illness is another challenge. One friend with experience told me that the role of the caring family member is to be the “guardian of hope” when the ill person is feeling hopeless. Giving encouragement, making invitations, offering to listen, giving space as requested — all these are truthful and caring responses.