Argue the Toss: 'White Lies' - Good or Bad ?
Something cropped up during the comments to a Nursing Times piece, and it is a really interesting 'issue'. The NT piece is here (but you need to register with NT to read some of its articles - and you need to subscribe, to read the rest of them):
Somebody posted this:
'I think people need some honesty and we should be doing our best to make that last bit of someones life as bearable as possible and that include their friends /relatives.There are things you can say to people that might not be totally true BUT you know it will make them feel better about a situation.An example of this was when a close friend of mine asked a nurse if someone was with his old mum when she died.He knew the score and had been at her bedside most days but on the one occasion that he was away,she died.He asked if anyone was with his Mum when she died.The nurse told him no one was with her BUT WHY didn't she lie and tell him that someone sat and held his Mums hand while she died,she was very peaceful and not in any pain !!!!! That is what he needed to hear to make him feel better,he would not have argued and asked if she was sure, it would have just have softened the blow very slightly,instead he still feels guilty about not being there ! But you need emotional intelligence to know when to lie .'
The next person commented on that:
'Totally agree with you about commiting terminological inexactitudes - bending the truth - lying; there are times when it's kinder to lie, especially in the situation you described, imagine if we always told the honest truth ! I have represented nurses who have both told the truth and/or lied about that very situation; you die if you do , you die if you don't. It would have been much kinder to the bereaved relative, to live the rest of their life, thinking their loved one was not alone when they died. Then again Julie, that's us; nowadays the decision would need to be evidence based, extensivley researched etc, you know what I mean.'
Then I threw in this:
'I'm not sure about lying to people, to 'ease their grief' - I just dislike the 'dishonesty' aspect. The sad bit about your story, is in my view this:
'He knew the score and had been at her bedside most days but on the one occasion that he was away,she died.'
My question would be this:
Was the lady who died alone in hospital, unhappy at dying alone - or not ?
If she wanted someone to be with her while she died, and there wasn't anybody free to do that, IT (current EoL care in hospital) ISN'T GOOD ENOUGH. And if she was unconscious and 'out of it', or if she had made it clear she was 'happy alone', why do you need to not just tell the truth to her son, when he asks ?'
The person who had made the first comment then wrote:
'Because Mike,the person who has died is not the one needing the comfort.When my friend asked "was someone with my Mum when she died" it was HIM who needed to hear that someone was,he could then picture in his mind some kind nurse sitting in the chair next to his Mums bedside but instead,because of the nurse saying no one was with her,the picture he has is that of the empty chair that he should have been in.It doesn't matter what the dead person felt now because there is no way of changing that.The dead person may have had no idea that anyone was with her to the run up to the big check out but the bystanders need the comforting.
No one will ever know if she "was unhappy at dying alone "so I can't answer that question Mike but its not always the person at the centre of an event that needs the most input,care and support.'
And I replied with:
'no one will ever know if she "was unhappy at dying alone "so I can't answer that question Mike but its not always the person at the centre of an event that needs the most input,care and support.'
I know that Julie - but if the son goes away believing that someone was with his mum when she died (and that belief comforts him), but then some time later he somehow discovers she was alone, and he was lied to, what happens then ?
That NT discussion reminded me of something a friend of mine had written in an e-mail, when we were discussing her mum's death:
'My opinion about how my aunts might feel is coloured by watching their behaviour when my mother died (only about 9 months prior to my father); they didn't hold my mother in much high regard and didn't really care whether she lived or died but they could see it was upsetting my father so they kept telling him that she was looking better and said "where there's life there's hope". He decided to listen to them which made my job of preparing him for the end pretty much hopeless.'
I am also reminded of someone who contacted me out-of-the-blue: a lady who was really upset by how her father had died in a hospital, to the point that she felt the NHS must be (to use my wording) 'somewhere between uncaring and evil'. The problem seems to have been, that her dad was 'frail but fairly healthy' when he was admitted, but very quickly his condition became terminal - but nobody properly explained that to the family, and as a consequence the family concluded that 'the clinicians wanted dad to die'. So moving her dad to a single room, wasn't seen by the family as 'providing some privacy' but was instead seen as 'hiding him away'.
It is a huge shock 'when a healthy loved one suddenly dies' as this person explained to me, when I asked if patients need to be told of terminal prognoses, and if clinicians believe telling the patient would be very upsetting should the relatives be told instead/first, someone posted the following on the Dignity In Care website:
'Hi in my opinion i think that the family should have a meeting with all the consultants involved and discuss there options first to see if any more can be done for the person thats involved if every thing possible has been done then the family and the consultants should go and tell the person in question that they only have hours or weeks to live why i think this is because i had to go thou some thing last year when the hospital told me my husband only had 2 hours to live and he had never been ill in his life it was very sudden.'
And it can look different if you are the clinician 'doing the telling':
'I saw a doctor receive a punch in the face after imparting the reality of a patient's condition. His crime? According to the patient, it was because the doctor had taken away his hope.'
This is an ENORMOUS issue in 'my area' of end-of-life behaviour, because almost everybody involved understands that it is far and away the best situation if the patient has made the decisions and everyone else is doing what the patient wants - but everyone also knows that it is somewhere between very difficult, and virtually impossible, for the 'conversation about your death' to be started: and the patient can't tell you what he wants to happen 'in the dying phase' if nobody actually talks about that bit.
THERE IS ALSO SOMETHING ELSE IN THE ABOVE: often 'telling a white lie' moves a problem from 'now' to 'the future' [and the professional who moves it, might not be the one involved 'in the future'] - and it also often moves the problem 'from my hands into someone else's'.
I don't think that covering up a problem by telling a lie, can ever be 100% 'white' - if telling a son that a nurse was sitting at his dying mum's bedside while she died covers up the fact that there were so few nurses on duty, that one could not be spared 'to sit with, and comfort, a dying patient who wanted someone to sit with her', then the lie also 'covers up the staffing problem'. Solving the staffing problem, by making sure that there are enough nurses for one to sit with any dying person who doesn't want to die alone, is surely an objective - so the lie doesn't help, does it ?