Is this ethical?

What Compassionate Validation is

It is the approach behind every call. Her feeling is treated as true and answered first: if she is worried that the car is unlocked, the worry is real even though the car was sold years ago, and the worry is what gets a reply. Facts are never argued. Nothing is invented: no memories she does not have, no promise to visit, no "I'll call you back". Comfort, not correction.

It draws on validation therapy, Naomi Feil's approach of meeting a person living with dementia in her own reality rather than pulling her into ours. It is not therapeutic fibbing. A fib adds a false fact to settle her: "the car is in the garage". Compassionate Validation adds nothing; it stays with what she feels and moves gently on.

Read the full definition of Compassionate Validation

Whose consent, and what it covers

You submit your consent before calls begin. It covers how your voice is used, what your loved one is told, and how calls are recorded and transcribed. You can withdraw your consent by contacting us.

Include your loved one in the decision as much as they are able. If someone makes decisions on their behalf, check that they have the authority needed for this choice. That depends on the circumstances and the rules where you live.

What we keep of your voice, and for how long

What we will never do

We will never phone her. The number is hers to call; it does not ring her, not for a reminder, not to check in, not on your behalf. We will never sell your voice, and we will never use it to train other models without your explicit consent; if we ever wanted to ask, it would be a separate question, in plain words, with nothing about your service changing if you said no. We will never insist if she asks whether it is really you. We will never argue with her reality: the year, the house, who is still alive. And it will never promise to visit, never promise to call back, and never say "you already asked".

If something is wrong

Every call is watched for three levels of distress: mild, moderate and crisis. For each one you choose what happens — no alert, a text, or a phone call to you. When she is upset the voice stays on the line and becomes gentler. It does not hang up on her, and it does not call 911; you decide what happens next. Afterwards you can read the whole call: the time, the length, a one-line summary, a note on her mood, and the full transcript. Outside the hours you set, her call rings your own phone, as it always has.

How a call works, step by step

What bioethicists say

Truthfulness is the default. The Nuffield Council on Bioethics, in its 2009 report on dementia, kept a strong presumption in favour of the truth, then asked what to do when the truth causes real distress to a person who cannot hold it. Its answer: her wellbeing comes first. Not being fully truthful can sometimes be justified, but only for her sake, never for the convenience of the people around her.

Truthfulness matters, but the person's wellbeing matters more; where the two conflict, her interests, not our convenience, decide.Nuffield Council on Bioethics, Dementia: ethical issues (2009) — paraphrase

What others in this field do differently

Different services take different approaches. Before choosing one, ask whose voice your loved one hears, how the service explains itself, whether it answers incoming calls, and how consent works.

Ours is different for one reason. The comfort is the familiar voice. A stranger's voice can keep her company; it cannot give her what yours does, the sound of someone she loves. So we keep the voice, make it inbound only, put the hours in your hands, and give you every word of every call. If you read the other choices and prefer them, we would rather you chose them than chose us uneasily.

For referrers

If you are a family physician, a First Link coordinator or a social worker, this is a short summary. The person who signs up, usually a daughter or a spouse, submits consent before calls begin and can withdraw it at any time. The person living with dementia is not told on the call that it is a recording, and the call never insists if she asks. What is recorded: the family member's voice during setup and the audio of each call. Call audio is kept in ElevenLabs. Written transcripts, summaries and mood notes are available to the account holder. Read about privacy and your voice.

The family member sets the answering hours, can extend them for an afternoon, and can stop at any time.

The page written for professionals, with a paragraph to paste into a note

Questions people ask about this