If you’ve been involved in the care of someone with dementia, you’ve probably faced this moment of truth: Should you always be brutally honest, no matter how hurtful that seems or how little you may be understood, or do you tell a “white lie” or create a deception in the belief that it’s more compassionate or comforting, or even convenient in the moment? In essence, how obligatory is it to tell the truth to a person with dementia?

This is no idle philosophic conundrum but rather the lived reality faced every day by dementia caregivers. Clinicians have terms for this dilemma, including therapeutic lying. And strategies have been developed, such as validating the emotions behind a dementia patient’s questions or concerns, as a way to respond. Clinicians may advise use of that validation as a path to redirect an otherwise difficult conversation or behavior. But it may leave caregivers in the awkward position of not directly responding to a patient’s question or concern, even if they are doing so out of kindness or compassion.

Several recent pieces in The New Yorker vividly describe this dilemma. One piece, written by the renowned neurologist Oliver Sacks, recounts the story of two different patients who are seeking a return to their professional identities long after they retired and moved into a nursing facility due to dementia. Sacks comes down on the side of playing along with their professional “identities” rather than insisting on a reality they would not understand. In another provocative New Yorker piece from last fall, writer Larissa MacFarquhar describes the new sorts of memory care facilities which care for dementia patients and create nostalgic, home-like environments so the patients feel like they’re still living in their homes. The truth-telling dilemma can be front and center in some of these facilities, as you can hear in this recent New Yorker Radio Hour conversation between MacFarquhar and David Remnick, The New Yorker’s editor. From the conversation, you’ll come to realize how the debate between dignity and deceit is often present on the frontlines of dementia care and there may be no clear answer as to when and whether it’s acceptable to not tell the truth.