Menschen mit Demenz anlügen und täuschen? Eine prinzipienorientierte Falldiskussion

In long-term care for people with dementia, communicative interventions that have the potential to deceive are accepted to varying degrees by nursing staff. Bus stops where there is no bus, false train compartments where a film simulates the passing landscape, covert medications in food, but also “white lies” occur. Such practices raise the question of whether and how they can be ethically justified and how the associated moral stress of the actors involved can be minimized.

Based on a fictional case in which a nursing home resident is prevented from leaving the facility with the help of a fake telephone call, I show that deception, as one of three possible courses of action, can be evaluated positively regarding the principle of beneficence, since the resident is prevented from leaving the home without coercion. However, the principle of autonomy is violated, since the resident cannot freely choose between deception and reality. With regard to the obligation to third parties, deception is problematic, since oriented residents who observe the scene may fear that they are also being deceived.

The synthesis of the different arguments shows that a walk, in combination with a conversation, which appreciates the feelings and motivation of the person, as an additional option reconciles the principles of beneficence and autonomy, but because of the time involved, it carries the risk of an unfair distribution of care resources.