The Blogs: My father is at risk and won’t let me help

What responsibility do adult children have to their aging parents? We all know that the Jewish tradition places great emphasis on respect for parents, but it does not specify how to enact this general principle – especially with today’s longer lifespans, more sophisticated medical options. The dilemmas are numerous, and one is presented here, along with the helpful insights of Noam Zion, Erica Brown and Sharon Cohen Anisfeld.

Today’s Jam

I am an only child and the primary caregiver for my aging father, who lives alone in his house about 20 miles from my family and me. Over the last few months, it has become more difficult for my dad to care for himself. I think it would be best for him to move into an assisted-living facility closer to my home, where he would have access to excellent health services, more engagement with peers, and regular visits from the family.

The problem is that my dad, who is still very sharp cognitively, does not want to leave his house, nor is he willing to have the level of in-home care I think he needs on a daily basis. In a recent conversation with a trusted social worker, he told the two of us that he would rather die prematurely than have people “fuss over him” or move into an “old-age home.” I love my dad and want to treat him with respect, but I really think he will ultimately be happier (and healthier) if he moves into the senior residence. What do you recommend I do?

Noam Zion says…

Rabbi Shimon bar Yochai, quoting Exodus 20:12 said: The most difficult of all mitzvot is Honor your father and your mother (Tanhuma, “Ekev,” 2). So let all those giving advice beware.

Jewish traditions offer at least three different perspectives on such interpersonal halakhot. First, ethical principles (din); second, relational considerations (i.e. how to achieve compromise, shalom bayit); and third how to nurture ongoing, if problematic, relationships.

Here peace is more important than who is right, since deciding who is right often alienates and exacerbates a situation. It is a mitzvah to withhold advice even when it would be good for the aging parent or the adult child, because they are not ready psychologically to hear the criticism – at least from you –and intervention will make them more stubborn and self-destructive.

In this case, our father is behaving internally consistently, even though we fear that he may be on his way to irrationality and self-injury. Therefore, the parent has a right to autonomy.

But more than that, we as his child are obligated to respect our father (Lev. 19: 3). For a son to treat him as incompetent would deeply dishonor him precisely when he, as father, most vulnerable to self-doubt about his independence. In our case, the child honestly worries about his aging father but has an argument stronger than his own concern to remove his own anxiety. The child may claim that he is obligated to pick up the pieces if his father’s willfulness leads to injury. The father who does not want anyone to make a fuss over him may be on his way to fall and break a hip and become a bigger burden, so he must consider the effects on others of his desire to be independent. The son must look for ways to help his father without shaming him, just as the rabbis use subterfuge to give tzedakah to someone truly needy but too proud to accept any help.

About Noam Zion

Dr. Erica Brown says…

Loss of autonomy and independence unquestionably compromises human dignity. It is perhaps the hardest price of aging, more burdensome in many ways than health-related issues because it is so emotionally charged. I feel for this son, and while I sympathize with Noam Zion’s thoughtful response, I did not read this as a well-intentioned son overstepping his bounds.

Children in Jewish law are not supposed to contradict or humiliate parents publically; this does not mean that they cannot differ with parents privately. This is even more true when the subject is the well-being of the parent in question. Just as there are certain decisions which parents cannot dictate for children despite the obligation to honor and respect them, there are areas where disrespecting parents is a sign of respecting them. If a parent is a diabetic and asks a child for candy, the child is not mandated by Jewish law to do something injurious to his parent’s health in the service and delivery of respect.

I know many adult children struggling profoundly with aging parents who make poor decisions about their own care. These are parents who should have given up driving years earlier and may injure themselves or others on the road. These are parents who cannot see well and take wrong medications as a result but refuse to have a caretaker assist. These are the parents who have a history of falling but will not wear a portable alert button or travel in a wheelchair because it would mean they look old.

If we merge the biblical verses “ushmartem et nafshotechem” – you shall surely guard your health (in the plural) – and “hokheakh tokhiakh” – you shall surely rebuke your neighbor – it reminds us that if we are to act in the best interests of the collective, we sometimes have to say what others do not want to hear to save them from themselves – even and especially when it comes to our parents. After all, they gave us plenty of unsolicited advice to help grow us into loving, compassionate human beings.

About Erica Brown

Rabbi Sharon Cohen Anisfeld says…

Just last week over a cup of tea at her kitchen table, my mother said to me, “This time of life is all about loss.”

She said this without rancor or self-pity, and I realized it would be absurd for me to try to argue. The point was for me to listen and learn. My mother has always been rigorously committed to truth-telling, and this is a truth with which she is currently trying to reckon – loss of physical and cognitive capacities, loss of independence, loss of long-time friends, loss of home. How does one orient oneself spiritually and emotionally to so much loss?

Those of us who have not yet faced the losses that come with old age have much to learn from those who are living with them every day – including both our own parents and others in our communities. The mitzvah of honoring one’s parents is about more than trying to compensate for the indignities that come with age. It is about recognizing that our parents can still be our teachers – even as they become more dependent on us for companionship and physical care. Our stance with them – as with anyone who is struggling with hardships that we ourselves have not had to endure — should be one of humility and curiosity. Al tadin et havercha ad she’tagiya limkomo, do not judge your fellow human being until you stand in his place (Pirke Avot 2:5).

There are, to be sure, situations in which adult children must step in to take responsibility for difficult decisions that their aging parents are either cognitively or emotionally unable to make – particularly if they are putting others at risk (as in the case that Erica Brown raises of a parent who should no longer be driving).

But that is not how I hear the case that’s been put before us. In this case, there seems to be no clear and immediate danger to self or others, and so I would agree with Noam Zion that, for as long as possible, the parent’s right to autonomy should trump the adult child’s sense of what he or she “thinks would be best.” It is, after all, enormously difficult to untangle the child’s concern for the parent from the child’s understandable but impossible need for control and reassurance in the face of life’s uncertainties.

About Sharon Cohen Anisfeld

Now, what do YOU say?

We seem to have two votes (Zion and Cohen Anisfeld) in favor of deferring to the father’s wishes for autonomy and one (Brown) who sees safety as the prime consideration. What about you? If you balance the considerations mentioned here: dignity, safety, need for control, and the wisdom that comes with life experience, how would you act in this situation? Have you faced similar dilemmas? Join in the conversation in the commenting section below.

And of course, if you have a dilemma you’d like us to address in the Ethical Jam, send it to EthicalJam@timesofisrael.com

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Ethical Jam is a project of the Center for Global Judaism of Hebrew College, Newton Centre, Massachusetts, which is working to create a rich pluralistic discourse on issues of vital concern to the Jewish community and to the world at large.