Musings of a phenomenologist

Science, psychiatry and random musings

Is it ethical to lie to patients?

Posted by soveda on October 8, 2009

I ask this question because a number of people have spoken to me about SPECAL care (Specialised early care in alzheimer’s… erm… care- it’s like PIN number). Back in August 2008 there was this article in the Guardian by media psychologist Oliver James. Author of this book: Contented Dementia, which discusses SPECAL and he thinks it is great.

Hang on a mo, have a look at the 4th paragraph:

“There is a desperate need for an alternative form of care. Believe it or not, my mother-in-law has discovered it. I must be the only man in Britain who would like my mother-in-law to look after me if I had dementia. She is called Penny Garner and her method enables family members or professional carers to deliver 24-hour wellbeing to people with dementias. Amazingly, we are still on good terms after spending a year producing a book that now makes her method available to everyone.”

The interesting article he wrote in August 2009 has been commented on by the mental nurse blog which is well worth a read, I have tracked down a copy of the RCN report on SPECAL so I thought I’d blog a bit on the evidence base.

Now read on:

There are differing views on SPECAL as seen in these two articles on the Alzheimer’s Society website here and here.

From what I can gather the SPECAL approach is based on Penny Garner’s belief that memory impairments can be used to help the individual with dementia. This seems to assume that memory impairment is the key problem in dementia whereas people working and living with people who have dementia will know that aggression, hallucinations, persecutory delusions and other BPSD are the most challenging parts of working with dementia.

I have been unable to find any data other than the RCN evaluation looking at the effectiveness of SPECAL. the RCN evaluation looked at the use within an inpatient setting, the data is qualitative and has no control group. The discussion doesn’t actually say whether it is an effective intervention or not, I am frankly not convinced. Lots of “people think it’s good” but no actual “it’s good because”.
So, in simple terms we have no idea whether it works or not, it might be a useful aspect of dementia care but we don’t know…

Is it ethical to lie to patients?

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4 Responses to “Is it ethical to lie to patients?”

  1. I think it would be ethical if it really worked. Certainly, if I were suffering from severe dementia, I’d want my carers to do whatever made it less unpleasant, whether that involved lying to me or anything else.

    But as you point out the evidence base for SPECAL is rubbish. And the fact that Oliver James likes it only confirms that…

  2. Thanks for this. I’ve been trying unsuccessfully to track down this RCN evalution of Specal. Is it online anywhere?

    • soveda said

      I’ve got a hard copy, I don’t know if it’s available online but I can email the authors’ names to you if you like.

  3. bostonboy said

    Once I was known as the third brighest guy in Boston…duh?
    12 months ago tests make me out as the dumbest guy on the planet!
    And my research on the subject gets moot results. The 36 hour day
    book may all be true and factual…but it is a horror tale with no
    helpful insights. No, I am not looking for “happy endings” But
    can anyone out there share their copeing story that is at all
    literate and functionl? My recommendation is Alzheimers or Dummies.

    Yes I have a very good doctor and feel reaonably up to speed on my
    situation. I am saddened by all who suffer.But I will not go quietly
    into the darkness…..never.

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