Therapeutic lying in dementia care: bridging ethical theory and professional practice in social work

Therapeutic lying is a common yet ethically contested practice in dementia care, particularly when individuals experience cognitive impairment and altered perceptions of reality. Existing literature has largely examined this phenomenon through normative ethical frameworks or professional attitudes, paying limited attention to how decisions are made in everyday practice. The social work perspective also remains underrepresented despite the profession’s involvement in dementia care. This article seeks to bridge ethical theory and professional practice by examining therapeutic lying as a situated and relational practice shaped by contextual, organisational and experiential factors. Drawing on existing literature and empirical insights from social work research, it identifies a gap between practice and conceptualisation, highlighting the influence of implicit knowledge on professional decision-making. The article proposes an integrated framework for ethical decision-making structured around three interrelated dimensions: person-centred, relational-contextual and organisational. Rather than prescribing fixed rules, the framework aims to support reflective and context-sensitive practice. The paper concludes by discussing implications for professional practice, education and organisational development, emphasising the importance of embedding ethical reflection within everyday social work intervention in dementia care.