Publisher Health

I’m in my early 70s, and I’m married to a man in his 60s. My husband’s father struggled with Alzheimer’s for almost a dozen years before he died. It was incredibly hard on everyone involved. And now my husband is in the midst of his own health crisis. He has had some significant cognitive decline in the past two years, which affects his ability to function to his satisfaction. He is constantly looking for his phone or iPad. He gets lost while driving. He sometimes asks me to help him send a text or email because he can’t remember how to do it. This causes him so much shame. He says he no longer belongs in this world. His dysfunction reminds him of his father’s decline, and he doesn’t want to put himself or others through that pain.

The neurologist is less than helpful. My husband does fairly well on 10-minute cognitive screenings, so he receives a diagnosis of mild cognitive decline instead of dementia. He has started to talk about suicide and is afraid I will stop him. He has asked me to commit to letting him choose his time of death. Frankly, I respect his choice and believe he has the right to decide for himself. He has also asked for help in researching the best way to kill himself. I have considered trying to help him with that but fear that I am committing or abetting a crime.

What’s the ethical thing to do? (And yes, I understand that what’s ethical and what’s legal may differ.) — Name Withheld, North Carolina

From the Ethicist:

I’m so sorry about the situation you both find yourselves in, and wish it were rarer than it is. We are, I agree, entitled to decide that losing the cognitive functions necessary for a life of autonomy deprives us of the possibility of a dignified existence. And so we’re entitled, in my view, to make plans to end our lives when that happens. Unfortunately, once it does happen, we may not be able to recognize our situation or to execute our plans. Even states that (unlike yours) have “medical aid in dying” statutes don’t allow such aid to patients with an impaired capacity for decision-making — it can’t be secured by an advance directive.

How do these broad principles and circumstances apply to your case? I’m not going to pronounce on the legality of helping your husband end his life — either now, when he remains mentally competent, or at some later point when, as he fears, he will no longer be. (A lawyer can tell you how your legal exposure will be affected by the details of your assistance given the laws of your state.) I will say that, inasmuch as it isn’t morally wrong for your husband to end his own life, it isn’t wrong for you to provide the advice that he requests.

But to deny that an action is wrong isn’t to say that it’s necessarily wise, or anyway, that you should hastily pursue it. Right now, your husband — distraught, suffused with shame, anguished by the prospect of sharing his father’s fate — could be prone to acting precipitously. Older men are far more likely to kill themselves than older women, and one reason may relate to gender norms; men may feel especially humiliated when they come to depend more on others. The fact remains that countless people lead lives of value while experiencing some noticeable measure of cognitive decline. They’re able to give and receive love, even joy. And it’s impossible to predict when deficits will cross into outright dementia, if this is what’s in store; there can be extended periods of stability. Advance care planning, prepared while your husband is legally competent, can give him at least some control over his medical future. In the meantime, I’d urge him to consider that his current impairment doesn’t mean his existence offers nothing of value, to him and to those who care about him.

Readers Respond

Last week’s question was from a reader who was concerned about vacationing in a country that has a poor human rights record. She wrote: “My husband and I are now retired and are looking forward to making some long-postponed, once-in-a-lifetime trips. Unfortunately, the country at the very top of our bucket list has an authoritarian government and a poor human rights record. … Our tourism dollars would directly support the local tourism industry and the people who rely on it for their livelihoods. But we’re concerned that it would indirectly support the regime in power, as well. How do we evaluate the ethical implications?”

In his response, the Ethicist noted: “The case against visiting isn’t so much that you’re actually going to be prolonging a bad regime (any effect would be microscopic); rather, it’s that there’s something inherently regrettable about contributing to the welfare of wrongdoers. … suppose there were currently a boycott in place that had support from credible representatives of the people of that country and was having, or was likely to have, positive effects in improving conditions there. If that were the case, you should honor the boycott. It can be good to participate in a political process even when — as with voting — your personal contribution has a minuscule effect on the outcome.” (Reread the full question and answer here.)

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I agree with the Ethicist. The government does not necessarily represent the entire population. I would not want a political outcome in the United States to make people reconsider visiting. — Theresa

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Letting the boycott gods decide whether or not to go is abrogating personal moral responsibility. — Larry

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A separate issue is whether it’s safe for Americans to travel to the country in question. Check the State Department’s list to make sure there is no travel advisory for this country, and if there is, do not disregard it. Making reckless choices that may require others to take on risks to rescue you from the consequences is itself unethical. — Anna

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One additional factor that should be considered is the fact that long-distance travel by jet is highly destructive environmentally. Anyone who is seriously concerned about global warming should reconsider any such travel that is purely for pleasure. — Ray

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My husband and I are retired and living in his birth nation, whose democratic government was replaced by a military dictatorship a decade ago. By all means visit your bucket list destination and, to the extent that you can, give all of your business to small hotels, markets, local stores and people on the streets. Avoid high-end hotels, restaurant chains, big time tour operators and other businesses that you expect might be owned by autocrats and their rich cronies. You’ll be rewarded by charming people who greatly appreciate your business and attention. — Douglas

If you are having thoughts of suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline or go to SpeakingOfSuicide.com/resources for a list of additional resources. Go here for resources outside the United States.