Larissa MacFarquhar's New Yorker article looking at different approaches to the illusions of the demented offers, along with the inevitable discussion of whether lying is ever morally good, a good look at the treatment of dementia patients now living almost exclusively in the past. I regret that all this Kantian discussion was not rounded out — and made more difficult — by the fact that powerful drugs are the norm in many residential facilities for elders. How common? Well, here's Norway worrying about it and here's our own CMS trying to reach the problem by requiring reporting and expanding the definition of psychotropic medication. The New York Times reports that one third of nursing home residents take psychotropic medication and a significant percentage of them are individuals without a corresponding diagnosis.
MacFarquhar's article presents the rise of memory houses as a response to possible overuse of chemical restraints but doesn't linger on how psychotropic medications administered off label for the convenience of staff and facility are a lie as well. Yes, psychological placebos are a lie and psychotropic medications administered not for therapeutic purposes but for institutional purposes are a lie.They are a lie about how many skilled nursing facilities lack the staff and the funding to promote human flourishing.
I wish her article had spent less time dancing on the edge of "to lie or not to lie" and had lingered much longer on the fact that living the truth is expensive, drains caregivers, and does not seem to increase resident happiness even if it is considered to increase resident dignity. Some lying may be inevitable, considering human frailty.
What kind or which kinds of lying to those who have demented illusions that may bring them comfort, if any, are moral? While we await the promised land of well funded well staffed dementia care, is the answer to the first question still the same?