Sunday, December 13, 2009


A reader writes that her mother is 77 years old, her father 85. Both suffer from dementia.

Her mother has been diagnosed with Alzheimer's disease. She shuffles when she walks and has forgotten how to crawl, which makes it difficult for her to get onto her knees in order to stand up after she has fallen to the ground.

"Her falls are soft lands so far," my reader writes, "but it is only a matter of time before she breaks a hip."

She is not a neat eater, but my reader is simply glad that her mother is eating at all.

Currently my reader's father retains responsibility for his wife's care, because he won't accept help from the caretakers his daughter has hired to help him.

Her father has always been "very judgmental" of other people and their appearance, and often quite vocal about it.

"I usually tell him that it is not a crime to be fat or disheveled or any nationality other than Caucasian," my reader writes.

Lately my reader's father has become verbally abusive toward his wife. As time progresses and her condition worsens, he grows more frustrated with the situation. In his wife's presence he expresses his frustration to his daughter about her mother's limitations and peculiarities _ how she wets the furniture or spills her drinks, can't walk right or is always packing to go somewhere when there is nowhere to go.

"He rolls his eyes and acts superior to her," my reader writes. "He is quite demeaning to her."

She interrupts her father during his outbursts and tells him that he is being rude to her mother, but within minutes he forgets and resumes his diatribe.

"I would like to shock him by being very rude to him," she writes, "but he would forget in minutes and start again. Perhaps, if I do it often enough, he might eventually get the point."

My reader feels a responsibility to respect her parents, and wonders when her effort to protect one of her parents from the other becomes a moral responsibility.

I don't know that being rude to her father in the hope of teaching him a lesson is a sound solution. As she says, her father may not remember the earlier episodes, let alone register the message that she is trying to send indirectly. There's also the risk that my reader's rudeness might become a vehicle for her own frustrations, rather than a means to an end.

The end of life brings with it many indignities and awkwardnesses, and with them come new ethical obligations and new perspectives on older ones. The obligation to respect one's parents is still there, but it takes new forms when a parent is struggling with dementia or extreme physical problems. If respecting one's parents conflicts with doing what is best for them, obviously their best interests must take priority.

In this case, if my reader believes her mother to be in danger, whether through abuse or through neglect, she is ethically obliged to protect her. Her obligation to respect her father does not extend to allowing him to bully her mother, especially when his doing so is clearly as much a symptom of his own disease as of his personality.

Her desire to respect her father's wishes and his role as her mother's husband is honorable, but it is incumbent on the daughter to do what is best for both parents, even if that means contradicting them or going against their own preferences.

If it becomes clear that his own medical issues make it impossible for her father to protect and care for his wife, my reader has a responsibility to shoulder that burden and ensure that every precaution is taken to protect her mother. If that means separating them or compelling her father to accept outside help, that is tragic but still the right thing to do.

We all have a moral responsibility not to stand by and do nothing if we see someone in danger and can do anything to help. That's all the more true - if also all the more complicated - if the person in question is a parent.

c.2009 The New York Times Syndicate (Distributed by The New York Times Syndicate)


brownewall said...

One of the most influential people in any elder's life is their primary care physician. Your reader should partner with their parent's physician(s) and find a way to influence her parents in making changes in where and or how they live, suggesting assisted living or whatever is appropriate for their current health. It amazes me how quickly elders react positively to their doctor's suggestions and if there are safety issues involved the doctor can step in legally and make necessary changes.

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