By KWAME ANTHONY APPIAH,AMY BLOOM andKENJI YOSHINO
I believe my 86-year-old spouse is in the early stages of dementia. He won’t see a doctor. I asked for some advice in an online caretaker’s forum, and a couple of people told me to tell my spouse some lie about why he’s going to the doctor and then have the doctor give him a cognitive test. I think it would be unethical to ever trick someone into doing something, but if he is slipping into this disease, he may be doing all he can to protect himself from knowing it. Is it ethical to lie to someone in order to help him? NAME WITHHELD
Kenji Yoshino: The first thing, which I suspect you’ve probably already done, is to exhaust all attempts at persuasion. I have a fairly constant belief in the ethical value of direct conversation. But I wonder if you’ve also tried an indirect approach: “If you don’t do it for you, do it for me.” People often do things for those they love that they won’t do on their own behalf.
Assuming you have done that, take him to the doctor and have him tested, even if that means some deception on your part. I’m kind of horrified that this is my reaction — if the ailment didn’t affect cognition, I would be inclined to say that deception is unethical because it infringes on your husband’s autonomy. You would be taking a decision about his own body away from him. But in the case of Alzheimer’s, the organ that’s making the judgment is the organ that’s potentially impaired. So in fact at some point it may not only be ethically permissible but ethically required for you to make that decision. At that point, it’s the Alzheimer’s, not you, that has deprived him of his autonomy.
Kwame Anthony Appiah: One thing that is not an ethical matter but a piece of advice: It’s important not to assume that you’re capable of doing the diagnosis here. One reason he needs to go to the doctor is that you may be wrong. Something else completely different may be going on. This might be a bad reaction to a drug.
Your baseline thought, that he needs to see a doctor, is right. So the reason you have an ethical question is that you’ve made the correct judgment. I agree that there’s a serious worry about infringing on autonomy, especially that of someone you love, because part of what he’s presumably worried about is that if he goes and gets this diagnosis, people will start to treat him as if he isn’t able to make decisions for himself. What’s going on is a fear of loss of control. I think in this conversation, which I’m sure you’ve already begun, it would be really helpful to reassure him that you understand that problem, that you understand why it’s scary, but that nevertheless there are reasons it’s important to go to the doctor.
Amy Bloom: I feel so strongly that it’s important for him to go to the doctor. What you may be seeing is a bad mixture of medications, a reaction to a new medication, the symptom of a tumor, symptom of severe anxiety. Because you’re not in a position to diagnose him, you have to help him go to the doctor. My guess is that at 86, he probably has a few other problems that might legitimately need addressing. So frankly, I don’t care if you emphasize an ingrown toenail as a
I know it is very difficult for somebody facing signs of cognitive impairment to hear that you understand and you’ll be supportive. The truth is, it all feels terrible and frightening and lonely. I think without lying, you can probably get him to the doctor by emphasizing some other difficulties as well as bringing this up.
Appiah: Just to underline one point about the autonomy: If you can do this in a way that doesn’t involve manipulating him, you won’t be speaking to the fear he probably has that this is what’s beginning once he gets diagnosed — a lot of people running him, manipulating him, because they don’t trust his judgment. So if you can do it without doing that, it would help with the fear he may have that he’s about to be disempowered.
Bloom: Oh, I agree. I think the straightforward approach is absolutely the first one. Having gone through this more than once in my life with relatives, I think the straightforward approach is often not successful, but it’s important not to give up at that point and think, Oh, there’s no way I can help.