Why is dementia different? Medical students' views about deceiving people with dementia

Abstract

Objectives: Care of patients with dementia raises challenging ethical issues, including the use of deception in clinical practice. This study aimed to determine the extent to which medical students agree that ethical arguments for and against deceiving patients in general apply to patients with dementia.

Method: Qualitative study using six focus groups (n = 21) and 10 interviews (n = 10) with undergraduate students in years 1, 3 and 5 at a UK medical school. Analysis using initial coding followed by comparison of data with a pre-existing framework concerning deception in clinical practice.

Results: Arguments for and against deceiving patients with dementia overlapped with those previously described in relation to clinical practice in general. However, the majority of participants highlighted issues unique to dementia care that warranted additional consideration. Three key dementia-specific considerations identified were capacity (understanding, retaining and emotional processing), perceived vulnerability and family dynamics. Students expressed uncertainty as to their ability to make judgements about honest communication with patients with dementia and their families.

Conclusion: Dementia adds additional complexity to clinical judgements about the acceptability of deception in practice. Medical students have a number of unmet learning needs with regard to communicating with patients with dementia and their families. Existing ethical frameworks may provide a helpful starting point for education about dementia care.

Keywords:

• dementia and cognitive disorders
• policy
• ethics and law
• qualitative methods

Acknowledgements

We would like to thank Dr Tony Young for his support in terms of focus group data collection, and all of our medical student participants.

Notes

1. In response to the following statement – It is acceptable to lie to a person with dementia if you think the truth might be upsetting to hear – 1.3% of participants strongly agreed, 17.6% agreed, 45% neither agreed nor disagreed, 29.7% disagreed and 6.4% strongly disagreed.

2. The scope of this paper does not allow us to present specific examples of justification and objections to deceiving a person with dementia that match those of Sokol's flowchart. Rather, we have chosen to concentrate on examples where dementia care might present additional complexities.

Additional information

Funding

Ellen StClair Tullo is supported by the National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre based at Newcastle-upon-Tyne Hospitals NHS Foundation Trust and Newcastle University. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.