A common problem of more severe traumatic brain injuries (TBI) is a complete denial of symptoms. This can significantly complicate treatment, as people with a TBI may be unwilling to accept therapies or interventions for problems they do not believe they have.
A recent case study described a TBI patient who exhibited combativeness, significant cognitive and motor impairments, as well as reduced awareness of his symptoms. He would not comply with treatment, and his recovery was suffering. The treatment team decided to use deception. The patient, who very much wanted to be able to work and contribute to his family, was told that he had been "hired" at the rehabilitation center. His specific job responsibilities were to participate in various therapies, take prescribed medications, and maintain behavioral standards. The patient accepted therapy and improved to the point that he could be transitioned to a day care facility.
Although the trust and autonomy are important ethical considerations between provider and patient, deception may be considered acceptable in extremely special circumstances, such as this case study. Other examples of deception under special circumstance are valid clinical situations such as paradoxical therapy or the use of placebos. While it should perhaps be a last resort, deception can have some efficacy in managing patients with TBI.
Matthes J & Caples H. Ethical issues in using deception to facilitate rehabilitation for a patient with severe traumatic brain injury. Journal of Head Trauma Rehabilitation. (January 2012).