Is it ever ethical for nurses to lie to patients

Jane Murray is correct. There are a plethora of situations and contexts where truth-telling in clinical practice is debated and arguments for and against exist. ¹ I have written elsewhere in this journal that a caring response is not necessarily always derived from strict rule following but rather to opt for a behaviour governed by the virtue of compassion. I have suggested that ‘a caring nurse responding virtuously acts by being compassionate, which may mean for a time accepting the prima facie nature of rules or principles of truth-telling’. ² Jane Murray similarly calls nurses to act guided by the prima facie principles of beneficence and non-maleficence.

I have had my ideas tested for sure. I think ideas about truth telling to our clients, our patients with or without dementia premised on harm minimisation – as we judge it to be in another’s best interest – need to be continually tested, challenged and called to account. I am especially aware of the propriety of telling the truth in aged care set against the damning report Care, Dignity and Respect 2021 ³ where nothing good is said about the state of older person care in my country, and I am very aware of the mayhem, the evil that prospers and the relationships destroyed when people spread fake news, catfish, sell scams and lie in business dealings and marriages.

Typically, I turn to the profession’s Code of Ethics for Nurses in Australia [CENA] (complementary to the ICN Code of Ethics for Nurses) to reorient my thinking about this topic, namely truth telling and whether it is ever ethical for nurses to lie to patients? ⁴

Throughout the various statements of the CENA we are asked to uphold ‘minimising risk for individuals’ and ‘recognis(e) the vulnerability and powerlessness of people’ in our care. This risk minimisation is found in Jane Murray’s suggestion that we can be comfortable telling lies to a person with dementia to reduce their distress. The caveat here would be that we have at the very least, negotiated this communicative strategy with the PWD during the trajectory of their care. An additional point made in the CENA, of use to me in this commentary, is the requirement that the profession ‘value(s) the contribution made by persons whose decision-making may be restricted because of incapacity’. The CENA adds quite clearly here that the nurse knows this and thus recognises the role of family-members and partners to then contribute to the decision-making process. The point I am trying to make is that to be in true relationship with the PWD means to engage with them in the trajectory of their care often and affectively, and to do so in the company of and with the family and partner. If we are to stray from telling the truth it can only be by mutual agreement by all parties concerned. For me, the poignancy of the CENA and this discussion about truth telling and whether it is ever ethical for nurses to lie to patients is the overarching sentiment of the Code that reminds us of our responsibility to ‘safeguard the inherent dignity and equal worth of everyone’. ⁴

As with Jane Murray’s research, I captured nurses caring for People with Dementia (PWD) telling lies – albeit the therapeutic lie where the care providers’ intention is central to telling the truth and the intention is to do good, prevent harm and foster well-being. Then, as now, my litmus-test for any advocacy of lying in clinical practice regardless of intention, motivation or sense of genuine empathy is the universal Golden Rule. ⁵ We need to ask ourselves ‘would I have this done unto me?’. ⁶