In Sickness and in Health, till Death do us part
I’ve written occasionally about Medical Ethics and the misalignment of incentives that pay doctors & hospitals for treating symptoms rather than keeping us well. As we consider reforms to contain runaway deficit spending, we must come to grips with many ethical questions. Since individual choices can determine our health and well being, and therefore the cost of care, we’re less sympathetic of people still smoke, drink or eat too much of the wrong things. We know that obesity is America’s #1 health & financial risk and that it can cause heart disease, stroke, diabetes and certain cancers. Since half of our population is overweight from lifestyle choices, should they get the same level of care at taxpayer expense?
A new question arose this week about medical ethics and marriage when religious leader Pat Robertson told his 700 Club television audience that divorcing a spouse with Alzheimer’s disease is justifiable. He was taking questions from the audience when Robertson was asked how to advise a man who began seeing another woman after his wife started showing symptoms of Alzheimer’s.
“I know it sounds cruel,” he said, “but if he’s going to do something, he should divorce her and start all over again, but make sure she has custodial care and somebody looking after her.” After all, it’s “a kind of death.”
Apparently “compassion is out of fashion,” according to New York Times columnist and economist Paul Krugman.
“During Monday’s G.O.P. presidential debate, CNN’s Wolf Blitzer asked Representative Ron Paul what we should do if a 30-year-old man who chose not to purchase health insurance suddenly found himself in need of six months of intensive care. Mr. Paul replied, ‘That’s what freedom is all about — taking your own risks.’ Mr. Blitzer pressed him again, asking whether ‘society should just let him die.’ And the crowd erupted with cheers and shouts of ‘YEAH!’”
Krugman’s article observed that the “freedom to die” even extends to children and the unlucky as well as the poor and foolish.
Are voters ready to embrace such a radical rejection of the kind of safeguards against “common hazards of life” through programs such as Social Security, Medicare & Medicaid, and unemployment insurance? We’ll find out next November.
Wayne, This kind of situation is not only associated with individuals with Alzheimer’s, but also other forms of illness or injury that is debilitating. For example, individuals with severe brain injuries may have severe debilitation, cognitive loss, and/or personality changes. Many marriages do not survive due to the complicated and stressful dynamics from finances, compatibility issues, and so forth.
Caretaking for a loved one is not for everyone and many times a willing spouse is not able, because his or her loved one may be violent, resistive to care, excessively wander, exhibit disturbing and/or inappropriate behaviors, etc. Many times with Alzheimer’s and brain injury, the individuals involved are relatively young. I must confess that I have mixed feelings sometimes watching the dynamics play out in certain situations similar to the one that Pat Robertson commented on. On a certain level, there is a betrayal factor on the part of the husband concerning his wife with severe Alzheimer’s because he moved on with another relationship.
Opinions are very strong concerning what is the right or wrong response in this situation for the husband. Because a person chooses to divorce a severely impaired spouse, does not mean that the person does not care about his or her spouses’ well-being. I have heard Pat Robertson’s comment many times from families; we don’t want to hear someone in Pat Robertson’s position even hint about divorce as an answer in any situation. I admire those spouses who devote themselves in the caretaker role and seem to fit the ideal of “in sickness and in health.” However, divorce is an option for some individuals, not necessarily because they are doing the wrong thing, but because they are trying to do the right thing for their particular situation. Still others will move on with an intimate relationship(s) and not divorce.
I cannot know the spiritual dilemma and suffering for both spouses throughout the disease process and I pray to God that in these situations that souls are drawn close to Him, in spite of our weaknesses. I watched the clip of Pat Robertson’s comment which seemed like not the whole discussion and the explanation of his comment was cut off and not aired. Misinformation about Alzheimer’s many times is part of the dynamics involved. Thanks to all for the insight.
Metlife did a similar study on “Caregiving Costs to Working Caregivers,” but I add this reply to share the following two relevant comments about family caretakers from Linkedin:
From Jim – I helped care for my parents for fifteen years. That sentence is easy to write but more challenging to live. I quit a good job, left my life in southern California where I’d live for 13 years and moved to Texas where I hadn’t lived in three decades. I became an overnight parent at 51, untrained, unemployed an unprepared. I was not paid for the hours of at doctors offices, the trips to the audiologist, three doctor days, hospital duty, hours pushing wheelchairs entertaining at the nursing home, learning how to deal with Alzheimer’s, getting two nonagenarians with broken hips in and out of my car. Learning how to put batteries into the hearing aids Dad wouldn’t wear. Keeping my mouth shut when my father told me how to drive.
Was I paid for this? Indeed I got a a bountiful reward: unselfishness (a new concept for me), patience, improvisation, the chance to know my parents on a non-holiday basis, a closeness that I’d never known before, a chance to “show up” when I was needed, the looks on their faces when I walked in the door, a crash course in flowers from my mother and the chance to memorize every WW-II story in my father’s vast repertoire. Most importantly, I learned to respect those who are nearing the end of life but want to live it as fully as possible. I figure I got several million dollars in character development and didn’t pay taxes on any of it.
From Gerry – My wife and I have been the primary caregivers for our parents. My wife has only worked 4 days a week for the last twelve years. While the income is not recoverable, we are grateful to have been there for good days that our mothers had while battling cancer, Alzheimer’s, and heart disease.