Saturday, June 2, 2007

Everyday ethics: Age-old challenge of caring for parents

I am a single, 62-year-old woman with a full-time job. Two years ago I allowed my 87-year-old mother, then quite ill, to live in my home with a 24/7 caretaker. Mother is now in good health, with mild dementia, but still needs the caretaker. I would desperately like them out of my home. None of my six siblings can take her in. What is my obligation? - Name Withheld, California

You (as well as your siblings) have an ethical obligation to see that your mother is well cared for, a task you've shouldered admirably, not a duty to make her your permanent roommate. But I suspect that you were not contemplating leaving her at the curb on recycling day, just lamenting the current arrangement.
It's easy to recognize this obligation - when we're children, our parents care for us; when they're elderly and need help, we look out for them - but harder to describe how to meet it. Finding a way to do so is something for you, your mother (if she is sufficiently lucid) and your siblings to discuss. In devising a solution, your happiness, too, is worthy of consideration.
Yours is not an uncommon problem. Nearly 22 million Americans with full-time jobs care for parents or other family members. There are many services - in housing, health care and transportation, for example - that you might not have considered. You can find some of them through the AARP Web site, the U.S. Administration on Aging or the geriatric unit
at your local hospital. As important as knowing your ethical obligation is learning pragmatic ways to meet it.
I am a retired orthopedic surgeon who volunteers at a clinic for the indigent elderly. I treated a woman who has obviously been crippled by a surgeon. She will soon lose the ability to walk and has chronic pain. She is unaware of her right to sue for malpractice. Am I obligated to inform her, particularly when I know that she will need the money for continuing care?
- Name Withheld, Florida

As you seem to imply, you must give your patient a true understanding of her present condition, and that conversation may reasonably address the past treatment that brought it about. If you were discussing the case with a colleague, surely you'd opine that the patient was ill- served by her last doctor. Your patient herself is entitled to the same candor.
Her legal options, too, are germane. Physicians often consider a patient's economic circumstances. As you note, the economic relief she might gain through the courts can have a significant effect on her medical care and thus is within your purview. You may not offer legal advice, but you should encourage her to seek it.
I understand your reluctance to disparage a colleague or embroil another doctor in a malpractice suit. But your primary obligation is to your patient's health, not to your colleague's reputation.

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