Welcome home! Please contact lincoln@icrontic.com if you have any difficulty logging in or using the site. New registrations must be manually approved which may take several days. Can't log in? Try clearing your browser's cookies.
Alzheimer's And Buddhism
Hi all,
Here is a question that I have been wondering about and I would be gratfull for any input that you all could give...
I am the Program Coordanator for a Day Treatment Program for those who suffer from Alzheimer's Disease and other related disorders. Often times, due to the massive brain damage caused by these disorders, the participants that we work with become anxious , confused and /or angry. Out of compassion and knowing that it would be difficult if not impossible for them to process thier current situation, we as staff will sometimes not be completely honest when we attempt to re direct a person who is having a difficult moment.
A good example of this is a woman who asks if her husband will be comming to get her. Due to her illness she is not aware thae her husband died several years ago. So, we might tell her that her husband will be at home when she gets there. Because of her memery loss after a few minutes she will not remember that she had this concsern and move on to a different topic. There are many other examples of this type of situation that crop up on a regular basis.
Although reality orientation is a part of what our program attempts to acomplish, there are times when it would simply be cruel to insist on telling a very affected person the full truth of thier current situation.
The concern that I have is whether or not being untruthful and re directing in this way are a violation of the Buddist precepts, or is it simply the use of skillful means to help ease the suffering of people who are very , very sick.
I suspect that I am over thinking this, but any input would be most welcome.
Here is a question that I have been wondering about and I would be gratfull for any input that you all could give...
I am the Program Coordanator for a Day Treatment Program for those who suffer from Alzheimer's Disease and other related disorders. Often times, due to the massive brain damage caused by these disorders, the participants that we work with become anxious , confused and /or angry. Out of compassion and knowing that it would be difficult if not impossible for them to process thier current situation, we as staff will sometimes not be completely honest when we attempt to re direct a person who is having a difficult moment.
A good example of this is a woman who asks if her husband will be comming to get her. Due to her illness she is not aware thae her husband died several years ago. So, we might tell her that her husband will be at home when she gets there. Because of her memery loss after a few minutes she will not remember that she had this concsern and move on to a different topic. There are many other examples of this type of situation that crop up on a regular basis.
Although reality orientation is a part of what our program attempts to acomplish, there are times when it would simply be cruel to insist on telling a very affected person the full truth of thier current situation.
The concern that I have is whether or not being untruthful and re directing in this way are a violation of the Buddist precepts, or is it simply the use of skillful means to help ease the suffering of people who are very , very sick.
I suspect that I am over thinking this, but any input would be most welcome.
0
Comments
My father died of Alzheimer's and he spent many years in a day treatment program and then, eventually, a full time memory care unit at a nursing home. We cherished the workers like you and your partners; you are a godsend (buddhasend?) to the patients and their families. Thank you, from the bottom of my heart, for doing the work that you do.
You know better than anyone the suffering you'd cause if you told them the truth, they'd get upset and then forget all about it only to ask the same question again later and get upset all over again.
I think the reason that not lying is a precept is to avoid dishonesty for personal gain at another's expense. Lying to protect a person with dementia from continuous confusion and suffering doesn't count as personal gain, so isn't against the precept, IMO.
Not only is it a directive of Right Speech, it is also part of the 4th Precept.
Would you rather violate this precept and be compassionate to another human, or would you rather strictly adhere to the letter (not the spirit) of the "law" and cause suffering to another?
I would rather violate the precept and ease another's suffering. To me, compassion is more "buddhist" than strictly adhering to a scripture.
I mean, just imagine a child runs into your office followed by a crazy looking man covered in blood and holding a knife, do you tell him where the child is hiding to avoid breaking the 4th precept?
I can't agree with this statement.
I have worked with people suffering from alzheimer's disease and other types of dementia. And just as Donna, I took care of a lady who wasn't able to remember her husbands death.
If you have ever been in a situation like that, you will know that telling such a person the truth is a harmful act, that will only bring the person suffering, until the memory disappears again...... and then I guess you suggest that we inflict that suffering again? and again and again?
I will gladly take upon me, the negative karmic effects of lying to such a person to ease her suffering. And I find it self centered and egotistical if a person inflicts suffering on another in order to rigidly hold on to a precept, by the fear of the negative effect.
If I am reborn in hell for these actions, then I i will gladly go - but I will never let doctrines dictate my actions, if those actions cause harm.
Much love
Samten
Given that it is one of the Buddha's main teachings, I accept it as a valid statement.
That you disagree with it, is not an issue with me.
It's an issue with the Buddha.
Good luck with that.....:D
If someone disagree and have a superior moral reasoning, I would like if you could provide a explanation from a moral point and/or karmic point of view (not from an analysis of the words written about this in Buddhist scriptures). Please
thank you!
It's lovely to meet you and like the others I want to thank you for the work you do.
I agree with the majority here. The intention to avoid causing suffering to the sick and vulnerable is more important than rigidly holding to any doctrine. Although I'm no expert, I would argue that the Buddha would agree as I have read stories to this effect in the Pali Canon (sorry for the lack of reference, don't have them at my fingertips at the moment.) and also because of his insistence that it is better to follow a Middle Way and to practice flexibility of mind and heart rather than hold to unyielding beliefs. Life is full of gray areas and one of the things I love about Buddhism is that it's clear the Buddha understood this fact because so much of his teaching shows us how to navigate such gray areas. There is a reason why wisdom and not obedience is 1/3 of the Buddhist path.
I don't know. I would find the best possible way in that particular circumstance, to speak the truth, and not lie.
This is an irrelevant point.
The OP asked, from a Buddhist PoV, on a Buddhist forum.
the moral/Kammic point of view, is based on Buddhist scripture, which I detailed above.
People seem to believe they can pick and choose at random, the bits they like, and the bits they don't like.
you either adhere to the precepts and consider the situation from a Buddhist PoV (and therefore accept the Buddha's instructions) - or you don't.
Frankly, it is not for me or anyone else here to judge or criticise others for what they choose to do. It's up to them, and whatever they choose, is whatever they choose.
But you cannot alter what the Buddha recommended.
It's that simple.
Days with My Father
I have to agree with most here that to releive the suffering of a person suffering from Alzheimers far outweighs the effects of a "white Lie" Personaly, there is no way I could look a person suffering from memory loss in the eye and tell them something to cause them more pain. That goes aganst every personal and proffesional instinct that I have.
I am sorry but I have to , with respect, disagree with your view on this.
I am curious, how would you handle the situation that I discribed? And what if it were a member of your family, what would you want a caregiver to say to them?
All of the Buddha's teachings are directed toward the end of suffering.
It really isn't that simple. Nothing ever is. Frankly I'm a little disappointed that you'd take such a black-and-white viewpoint. Forgive me if I'm being presumptuous, but I'm guessing you've never really dealt with someone suffering from Alzheimer's before. My mother-in-law lived with us for a few years. So everyday it was on my wife and I to care for her and to calm her when she would start to get upset. Quite often this would entail telling little white lies to diffuse the situation. A lot of times it might be telling her that her car was in the shop when she'd look out the window and see that her car (no car in fact) was sitting in the driveway. Sometimes it would be telling her that her father (who had died many years before) was on a fishing trip when she started asking where he was. Trust me, telling her the truth would only upset here. Quite often she would get physical when she got upset, thus potentially harming not only us but herself as well. I don't believe the Buddha intended his teachings to be strict, inflexible dogma to be adhered to without regard for circumstance. Alzheimer's wasn't known in his day. Were he here today I doubt he'd see much issue with this.
The point behind following the five precepts--at least, initially--is to recognize common pitfalls in avoiding attachment and unnecessary suffering.
If being honest would cause unnecessary suffering, then the spirit of the teaching is being sacrificed to the letter of it.
I'd be fascinated if there were a story of Buddha encountering a person with dementia or similar disease. Although, given the nature of religious texts, I would imagine the man would be miraculously healed by the Buddha's mere presence.
I almost quit that night, because lying went against everything I believed and was taught. I voiced my objection, and rejected several well-meaning suggestions like "It's not you doing the tracing, and you have the other worker call the police, so technically..." It was still lying.
I ran to my Zen Teacher, who straightened me out. Nobody was forcing the person to call a suicide prevention hotline. What we are about is part of the name, even. I had to assume that no matter what the person says, the fact they called us means some part of them is crying for help. So help them. Even if it means lying. Doing the correct, compassionate thing always trumps the rules. Always.
I understand the reluctance to say that any lies are all right. It's easy to fall into the trap of justifying what is the easiest thing to do. You can end up abusing it, like saying to yourself, "I'll lie to my wife and tell her I didn't kiss that girl at the office, because the truth will only hurt her. So the lie is for her happiness, not mine."
But there are times when lying is the correct thing to do. To help a confused alzheimer patient and the caretaker make it through the day? I can't see a problem.
I didn't say that it didn't exist, I said not known. There was little to no understanding of the disease until recent decades.
I prefer not to think of the Buddha as some sort of "eastern Jesus" figure.
Me neither. Yet you'll struggle to find people who don't instantly fall on the floor prostrating at his feet in writings, or animals that don't obey his every command. My point was that scriptures tend to paint an unrealistic picture of Buddha and the people he lived with, so we're unlikely to ever find a quotation where the Buddha is placed in an awkward moral situation without him magically resolving the problem.
Contented Dementia
and an organisation that uses the same technique - if you can call it a technique:
SPECAL
I hope that, as my own cognitive faculties continue to deteriorate, that I am cared for by people who are more concerned for me and my well-being than any sort of rules, precepts or inhumane directives.
I was just about to recommend the same book!
To my mind it is a compassionate act; also if you are willing to take on any negative kamma from not adhering strictly to the absolute truth at all times then I don't see a problem. That again would be a compassionate act.
Metta
While lies of any kind are also included, the bodhisattva vow takes precedence. If you are going to needlessly harm a sentient being by a doctrinaire application of the precepts it is considered a break of the bodhisattva vow. The intent of the OP is not to deceive another, but to protect them from harm. As another example:
You are in Holland during WW2 and were hiding your Jewish neighbours in your basement and German troops arrived at your door. They ask you, "Where are your neighbours, the Goldbergs?" Do you say, "Oh shoot, you got me there. I am a buddhist so I can't lie to you. They're hiding in the basement beneath a false floor." That kind of truthfulness is very harmful.
Due to the nature of the work that I do, I try to keep up to date with the most current research toward an effective treatment or cure for AD.
Sadly, many of the people directly involved in the research have stated that it will be many decades before anything truly effective comes along. Just last year a neuro scientist commented at a confrence that "we don't even know how a basic nerve cell operates" I have heard very much the same comment over and over.
So, then I go to work and a family member of one of our participants mentions an article they saw in the newpaper about a "breakthough" in the field and how there is always hope for thier loved one. Often, having had seen the same report, I know that, while a good step, the research mentoned is a long way from a treatment.
I always wonder if I should be honest so I do not give false hope, or do I keep to a more positive note and argee that one never can know or another more general response.
After having been a caregiver to my Grandmother after her stroke and due to my proffesional life , I understand the intense stress and heartbreak that families are under and will usually take a more positive approach. Although I know that there is often a lie in what I am saying, I just do not have the heart to look someone in the eye and take away their last shred of hope.
Thank you all for your comments ! They have been very helpful to me.
Dan
Dan,
Back in the early '80s, we had the same problem around 'cures' for HIV/AIDS. Early death was almost inevitable, and family and friends would turn up with some new nostrum or 'breakthrough'. I agree that we cannot pull the rug from under them, while, at the same time, we were addressing competent (if mourning) individuals. We would thank them for the information and assure them that we were closely examining every advance. We would join them in their hope that something new would soon be discovered - and, indeed, so it turned out. It is vital that you, too, hold onto hope. No need to lie; just tell the truth compassionately.
I like the way you put that very much.
I think you may be getting too hung up on the "Alzheimer's wasn't known then" and maybe missing my overall point, which was that I doubt the Buddha would take much issue in telling little white lies in such a circumstance.
thank you Brigid for sharing that link.
but moral (precepts) is to eventually be understood, experienced and realized. This is wisdom.
Then this understanding can be discussed, coming from our own realizations, not from our thinking minds (which is to be avoided i believe).
this is what I was asking for.
My father would ask about his mother who had of course died many years earlier. At first my Mom told him she had died, and he cried as if hearing the news for the first time. And in his mind, it WAS the first time. The next visit he would ask again. Imagine having to mourn your parents death over and over and over....all to keep a precept? I think not. We began telling him she was doing well and living in the town he grew up in, and he would smile. I cannot see any good reason to tell him the truth, certainly not if I am thinking of his best interests.
He died within a few months of the dementia becoming really bad, and I would have lied to him all day long to make his last months as happy as possible.
In the Mahayana case however, there is the story in the Lotus Sutra of the father who lies to his children telling them he has new toys for them to entice them to leave a burning building. So we do have scriptural evidence that these precepts are to help us, but they are not "thou shalt not's" and I am certain that Shakyamuni realized that the world is not black and white.
I think we are best to choose mindful compassion over mindless adherence to rules.
As patb said, it takes wisdom to know how the precepts work in the world and strength to accept the kamma of our decisions.
metta
Much mischief can be created when people feel morally justified in lying, or committing some other prohibited act, in order to (supposedly) benefit someone else.
First, there is a possibly erroneous assumption on the part of the liar that he or she is actually benefiting the other person. Second, the person being lied to may act upon the lie in an unanticipated way that causes harm.
Furthermore, there is the threat of a slippery slope when lying for benevolent reasons. "If it's okay to lie to protect someone from emotional trauma, isn't it okay to lie to protect them from mere discomfort? And why not lie to protect myself from trauma? After all, losing my job/girlfriend would certainly be traumatic to me so..." etc etc.
It is common for people to bring up the hypothetical cases of the axe murderer at the door, etc. But the point is that for most people, most of the time, these extreme cases will not be present. Instead, they will be dealing with gray areas where they will be tempted to lie to prevent mere discomfort or to gain some advantage.
The value of having a strict rule against lying, especially if that rule says to NEVER lie, is that the adherent will only break the rule in the most extreme cases, such as in the above examples.
People are naturally tempted to lie in many cases, thus rules against lying should be written to take into account people's natural dispositions towards bending those rules.
In other words, if we want people to drive 75 mph, then we make a law that tells them to drive at 65 mph, not 75.
Alternatively: Would we really want to tell kids, "Never drive drunk...unless you have to" ?
The difference is that laws are conventions that people have not chosen. When you deal with buddhist precepts, nobody is forcing people to respect them or not. The practitioner has accepted these rules on their own by choice. One would expect that they are approaching the precepts in good faith.
What is key is motivation. If someone is bending the rules just because they don't want to feel discomfort *themselves*, that is directly contrary to the intent of the vow not to lie. Please keep in mind that the whole point of the pancashila precepts is ahimsa, not harming.
If you are causing an Altzheimer's patient emotional pain by reminding them of things that they are soon going to forget because of dementia, you are harming them. If you do it out of a mistakenly doctrinaire position on the following of precepts, that's just punishing others out of a desire for moral purity. There are plenty of examples of Lord Shakyamuni bending the rules to preserve their intent rather than their letter.
Your point is well taken that it is easy for a certain kind of person to be disingenuous, but the fact is that regardless of the precept they will find a way to circumvent its intention or rationalize why they don't follow it if they have that attitude.
The residents that adamantly wish to leave are allowed to. And when they exit the building they see a familiar sight: a bus stop. So they sit and wait. And while they wait they begin to become less agitated. And a caretaker will approach them and offer them a beverage and invite them back inside to wait.
After a while, once the agitation has passed, so to does the desire to leave.
I dont know how many of you have duirect experience with caregiving for an Alzheimers patient. This disease is oneof the greatest spiritual challenges facing humanity, It is the greatest spiritual challenge for the caregiver and the most horrific disease ever.I caregive my mother for many years, she is violent aggressive abusive and sometimes dangerous she suffers terribly. i have watched her mind and body deteriorate, she has been a challenge for the community for aides, drs, anyone coming into cntact with her.To tell my mother the truth about something that could possibly do her more harm is spiritually irresponsible. YOur motive is everything. If i decide to murder my child when i hear rhe nazis coming up the stairs to fry my child in an ovenor do an atrocious experiment on this baby if i decide to mercifully and quickly murder my child maybe i will have to reap some consequence. who knows? not everything is black or white .and until you have had to caregive an alzheimers patient that is family you will never truly understand what compassion is or selfless service to give up ones life in the service to another we can talk about ending everyone elses suffering for many incarnations. go to a nursing home and take care of a poor soul suffering with this disease. you will get over your self very quickly and the concept of impermanence will be a challenge
kind regards to all of those who generate compassion with pure motive
Let's be kind when we can.
Let's be truthful when we can.
And let's try not to make a federal case out any of it.
Amen, brother.
"If you are causing an Altzheimer's patient emotional pain by reminding them of things that they are soon going to forget because of dementia, you are harming them. If you do it out of a mistakenly doctrinaire position on the following of precepts, that's just punishing others out of a desire for moral purity."
Thanks, karmadorje.
It's a good guide to use for avoiding harmful speech but white lies or evasive answers might be kind and necessary. Two out of three.
Ask: Is it True? Kind? Necessary?
Using Yoga's Principles of Mindful Speech to Think Before You Speak
Here's a link: http://www.suite101.com/content/the-principles-of-mindful-speech-a28627