Respecting agency in dementia care : When should truthfulness give way?

Memory loss and other cognitive decline threaten people's capacities to make sense of the world and their position within it. In Alzheimer's Disease (AD), such losses occur when the desire to make sense of the experienced world remains. When this desire cannot be satisfied, confusion, agitation, or anger may result. In these situations, a resolution aiming at the truth is not guaranteed to work, and may even exacerbate a difficult situation, since losses to sense making may damage even the receptivity to it. When the truth is out of reach in this way, the aim ought to be instead to create the conditions of proper fit – a fit that is intelligible – between current experience, self-image, and a world that makes sense. We argue that this aim rests on what we call the demand for sense-making, a demand that arises for all of us where respect for agency is at stake, and especially so in AD, when it is under threat.