The magazine’s Ethicist columnist on whether it’s appropriate to offer an unsolicited medical diagnosis.When our neighbor died a few months ago, his companion was grief-stricken. Although she lives separately in a rural town an hour away, they spoke every day. We knew her hardly at all, but she asked us to keep an eye on the now-vacant home, which she will eventually inherit.Now she comes periodically to sort through our neighbor’s possessions and prepare the house for sale. In doing so, it has become apparent that he was a hoarder, and she has turned to us again — for help in understanding the value of many of his things and for physical help with the sorting of them. She is overwhelmed. Her movements are slow, her decisions are hesitant and her stamina is limited.I happen to be a retired neurologist. Over the course of many days spent helping and observing her, I’ve become convinced she has Parkinson’s disease. I concluded that much of the slowness and hesitancy we initially attributed to her shock and emotional fatigue is, instead, a result of her as-yet-undiagnosed neurological illness. With the passage of time, I am increasingly confident of my observations.There’s been no occasion to mention my professional background, and I’m now uncertain about whether I should tell her about it and my clinical impressions. Her disease, at its current stage, is likely to be successfully managed with oral medication. However, it is neither obvious that she will have access to skilled neurological care nor that she will be willing to seek it. And a new diagnosis of Parkinson’s, without prompt treatment, on top of her recent loss and the challenges that have followed, may further overwhelm her. My wife is in favor of my informing her, because treatment would benefit her quality of life. I’m hesitant, as there has been no invitation to become more involved in her personal life, and I cannot provide her with a supportive doctor-patient relationship. What would you recommend? — Name WithheldFrom the Ethicist:You offer two reasons for not saying anything. One is that she hasn’t asked for your involvement in her personal life. Given that she knows nothing of your qualifications, though, she has had no cause to. The second is that the information might bring her distress without any benefit. But as a former professional in the field, you’re in a position to reduce that risk by advising her how to access the necessary care. Treatment that could help alleviate her symptoms would be the best outcome. Surely you would want to know if you had a treatable medical condition.I wonder whether you’re worried that if you tell her what you’ve noticed, you’ll be drawn into her life in demanding ways. After all, you’ve probably spent a lot more time in your neighbor’s house than you had expected. But you can draw a clear boundary here: You’re not her doctor and you’re not going to be her doctor. You happen to be qualified to give her some medical counsel that could lead to treatment and substantially improve her ability to function. You’re not offering to be her Virgil through the underworld of neurological care.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The magazine’s Ethicist columnist on how to assist a spouse in the midst of a life-or-death dilemma.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 RespondLast 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.)⬥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⬥Letting the boycott gods decide whether or not to go is abrogating personal moral responsibility. — Larry⬥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⬥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⬥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. — DouglasIf 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.

The magazine’s Ethicist columnist on helping people who are institutionalized against their will.Five years ago, I began volunteering as a bill payer for a legally blind, 95-year-old woman on public assistance. The job involved handling paperwork that clients could no longer handle themselves, thus helping enable them to remain at home. I came to learn that this woman had no family or friends left, and she came to think of me as her only friend. During my time with her, she was also put under the care of Adult Protective Services (A.P.S.), because one of her caregivers was fraudulently using her credit card.Last August, she fell out of bed in the middle of the night. A caregiver found her the next morning and called 911. She was taken to the hospital, treated and then sent to a rehabilitation center in a nursing home. After 100 days, as per her insurance, she was now considered a long-term patient.She is now 100 years old, blind and lying in bed 24 hours a day, except when I visit her and take her to the patio in a wheelchair. She is in an unfamiliar place and hears screaming, crying and cursing all night from other patients. She is relatively lucid despite her circumstances, and the only thing that is keeping her alive is the hope that she can go back to her small studio apartment soon, a place where she has lived for 50 years. She has said she wants to die if she can’t go home.Because she was protected by A.P.S. and is now in a guardianship arrangement under the care of the nursing home, I can no longer legally pay her bills or take care of any paperwork. This has meant that her rent has not been paid, and eviction proceedings are in the works. I have tried to get myself listed as a contact for her, to at least be able to advocate for better services but have come up against a wildly frustrating Catch-22 situation. She has been deemed incompetent by the nursing home and therefore can’t name me as a contact. I requested to have her evaluated again, because I don’t believe she is incompetent, and the answer was that only her contact can make that request.My question to you is, Do I tell her the truth, that she is never going home? Will taking away that hope make her give up her will to live? And should her will to live be based on a false premise? The social worker at the nursing home won’t even talk to me, because I am not a legal contact, and so the decision to tell her the truth lies with me; she has no one else. — Name WithheldFrom the Ethicist:This story is heartbreaking and, I fear, all too common, as “kinless” older adults grow in number. All sorts of factors play a role, some benevolent. These include an attitude toward elder care that puts safety ahead of freedom, and the well-intended use of provisions, like the guardianship process, that deny people their autonomy.Nursing homes aren’t always unaffected by financial incentives, either: the hundred days of rehabilitation that Medicare can mostly cover followed by the Medicaid-funded long-term care that, at a lower rate, still keeps a bed filled. Petitioning to have patients deemed incapacitated, with guardianship assigned to a third party, can make bill collection easier, too. What’s unusual here, I suspect, is mainly that you’re around to bear witness to it.There might be an institutional temptation to keep her in the dark so that she will be easier to manage. But it’s her life. She has a right to know as much of what is happening to her as she can understand and a right to respond accordingly. First, though, be sure that she has exhausted her options.You can try to convey your concerns to a long-term-care ombudsman, who, by federal law, serves as an advocate for residents. Your state probably also has an elder-abuse center and elder-advocacy groups that you could consult. This woman simply wants to live out her days in her own home. That shouldn’t be too much to ask.Yet her options, and yours, are sadly limited. There’s a need for systemic reform here. “We are too easily willing and able to justify radical measures such as guardianship and do not yet have more humane, dignified solutions in place,” Laura Mosqueda, an elder-care and elder-abuse expert at the Keck School of Medicine of the University of Southern California, tells me about cases like the one you describe. As our bodies and minds grow frail, conflicts arise between protecting us and respecting us; institutional arrangements meant to save us from misery can end up inflicting it.Readers RespondThe previous column’s question was from a reader whose nanny had informed her that a close friend was mistreating her own nanny by underpaying her, withholding food and reneging on promised benefits. Our reader wondered what her ethical obligations were in this situation. She wrote: “This friend introduced me to her circle of friends a few years ago, and it’s because of her that I am part of a great group of women. Should I intervene and risk her behaving even worse toward her nannies and creating a rift in the friend circle? Or do I say nothing and continue with business as usual?”In his response, the Ethicist noted: “If you bring up what you’ve heard with your friend, she will know that her nanny has been complaining about her — and may retaliate. Because her nanny is vulnerable here, make sure that whatever you do has her approval. … If she doesn’t want you to speak up, you could wait until the next transition. If that’s not going to happen soon, you may feel you have to distance yourself from your friend without saying why. Abusive behavior makes someone unappealing company.” (Reread the full question and answer here.)⬥Do you want to look the other way, knowing this person is abusing her power over her employee? If your friend gets mad at you for speaking up, it says more about her. You should be able to live with a smaller circle of friends who treat all people with dignity, rather than a larger group who do not. — Richard⬥I appreciated how the Ethicist responded to the greater possible legal ramifications of the situation for nannies and other domestic workers, since they are a group often overlooked due to classism, racism, sexism and the isolating conditions of the job itself. His advice was spot on about going through the nanny before taking any action to avoid unwanted retaliation. — Courtney⬥The Ethicist’s advice to not jeopardize the current nanny’s job is so important. This job, despite the alleged abuse, may be a critically valuable source of income. Waiting to bring it up until the next “nanny transition” is good idea. At the very least, getting the current nanny’s approval is essential. — Tom⬥The letter writer could talk to her friend about how much she values and appreciates her own nanny and how protective she feels toward her. She could give examples of different ways that nannies get exploited and share her disgust that people behave in such awful, inequitable ways. This would serve the same purpose of providing a moral compass without risking the career of the friend’s nanny. — Deborah⬥This is an opportunity to help your entire circle of friends appreciate the importance of how we treat those who have less power than us. You can provide other examples and avoid having your abusive friend trace this back specifically to her and her nanny. The goal is for her to see her own behavior deemed inappropriate by you and all your mutual friends. — John

Early next year, I will have bariatric surgery. My surgeon has told me that my initial weight loss will be significant and very noticeable. What is my obligation to share the reason for my future weight loss with people outside my family and close friends?I am not ashamed of having the operation, and I will not lie and say I experienced some sort of miracle wherein diets and exercise suddenly started to work for me. When I was pregnant, however, people seemed unable to resist commenting on my size. (“You’re huge!” and “Are you sure it’s not twins?”) This experience has put me on guard; I don’t feel I owe colleagues and strangers answers about my health or my body. But, for instance, my boss and I work together very closely, though I do my best to maintain personal boundaries. Do I owe her an explanation for why I will take a period of sick leave and thereafter look quite different? How do I negotiate the line between the truth of my weight loss and the truth of “it’s none of your business”? Name WithheldI agree that you have no obligation to explain to anyone what’s happening. It’s your body. Still, people in your life, including colleagues, may want reassurance that you’re OK. Sudden substantial weight loss can be a sign of disease. It would be courteous to assure people who care about you that they don’t have to worry. If they ask, you can let them know that you’re well and that the weight loss is intended; you can even signal — if you’re comfortable doing so — that it’s a result of a medical intervention, while also signaling that you’re not eager to discuss it. (“The wonders of modern medicine. Next subject?”) Personal boundaries are valuable, but relationships among human beings are seldom purely transactional, and sometimes it’s hard to harmonize privacy with caring and curiosity.My mother-in-law has always had poor impulse control, speaking without considering the consequences of how her statements might affect others. In addition, she has been racist and antisemitic for years. Now she has medical issues, including a form of dementia, and she needs care in order to stay in her home. Her lack of impulse control and abhorrent language have only gotten worse.My husband and I are torn about how to address this with her home-care service. We want her to have the best help so that she can stay in her home as long as possible, as is her preference. But we don’t want to subject home-health-care workers to verbal abuse. We also feel strongly as a matter of principle that acceding to racist or discriminatory behavior serves to endorse and perpetuate that behavior. Should we stay silent, hoping that whoever is assigned her care is acceptable or superhuman in their tolerance, or should we discuss this with the agency? Name WithheldOffensive remarks are easier to deal with when taken to be a sign of someone’s condition, not of her character.Do tell the agency in advance about your mother-in-law’s needs and propensities; they won’t stay secret for long. The agency and its employees can make decisions that they consider appropriate for such a patient. I assume that before your mother-in-law had dementia, you protested when she said abhorrent things. There’s no reason to stop doing that, and you can tell the helpers that they should feel free to express their objections, too. Bear in mind that many professional caregivers will have training and experience when it comes to the inappropriate verbal and physical behaviors that certain patients with dementia can be prone to. That a caregiver won’t have known her before may have advantages. Offensive remarks are easier to deal with when taken to be a sign of someone’s condition, not of her character. In my work as an immigration-policy analyst, I often hear, by email or telephone, from a sad group of U.S. citizens. They report having been tricked into marriages with noncitizens who were only after green cards. The noncitizen, in all cases, has broken off the marriage. The citizens are heartbroken and, often, financially broken. These citizens are routinely much older and, I suspect, less marriageable than their noncitizen partners. Sometimes the noncitizens claim (falsely, the citizens say) that they have been abused by the citizens; this usually results in a green card for the noncitizen, who becomes a successful “self-petitioned” immediate relative of the citizen. Often the citizen tells me that it actually is the noncitizen who has beaten them, ignored “stay-away orders” and/or broken other laws. Should I bring these seemingly illegal acts to the attention of law-enforcement officials, even though I have only one side of the dispute? David S. North, Arlington, Va.The exploitation you’re describing is obviously wrong, even if the inequitable circumstances that prompt the wrongdoing are also morally wrong. But these are cases in which authorities have already reviewed the evidence and decided that an applicant is eligible for permanent residency; it isn’t apparent why they should revisit their determinations on the word of a third party who has no independent access to the facts.The self-petitioning provision you refer to has a compelling rationale. Noncitizens who are victims of domestic violence or cruelty can be particularly vulnerable: They may not know English or be familiar with American laws, and they may fear deportation if they seek help. But the authorities are well aware that the system can be abused. While these petitions have substantially increased in the past several years, so has the number flagged as potentially fraudulent. The Government Accountability Office, which conducts audits and evaluations for Congress, has asked the United States Citizenship and Immigration Services to develop an anti-fraud strategy, and the agency has undertaken to do so. The objective is to try to protect victims of abuse without encouraging wrongful claims against the innocent — no easy thing to calibrate. The mills of bureaucracy grind slowly, but they do grind.What you can do, though, is to make sure that your correspondents seek assistance from law enforcement if they are being assaulted. Nothing prohibits the authorities from investigating if the victims themselves are able to report evidence of their mistreatment.I wrote a book and self-published it through Amazon, which lets the author mask that fact by listing a faux publisher on the title page. My first question is whether using the identification of a faux publisher is ethical. My second one concerns the following incident. In a local bookstore I inquired about leaving some copies of my book on consignment. The owner agreed. As I was leaving, he asked who my publisher was. Knowing that some bookstores don’t like to sell self-published books, I named my faux publisher. Was my answer ethical? Name WithheldVast numbers of self-published books appear each year, often ornamented with the names of fanciful presses. The practice isn’t really troubling. Had you chosen a vanity publisher instead, they would have decorated your book with a grand name that, while referring to an actual commercial enterprise, would have been no more or less misleading. We can easily imagine invented names that would be deliberately deceptive: Random Home, Farrah Strauss. But you’re not appropriating the cachet of an existing publishing house.As for your exchange with the bookstore owner: Had he typed your putative publisher into a search engine (as I’ve just done), he would have immediately seen that it wasn’t a real entity. Anyway, self-published authors are going to be the ones consigning books on their own account. That you hoped to mislead him, though, puts you in the wrong. He may not see a big distinction between Kindle Direct Publishing, vanity presses and publishing outfits so obscure they have never appeared on his inventory lists. But even if he wasn’t seriously misled, he would have reason to wonder about your honesty. A personal inventory might be in order.Kwame Anthony Appiah teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to ethicists@nytimes.com; or send mail to The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018. (Include a daytime phone number.)

The magazine’s Ethicist columnist on a physician’s duties.I am a physician, and last year, I took care of a white female patient in the hospital for a bacterial bloodstream infection. A few days into her stay, she began referring to Black staff members by the N-word and to our receptionist by an anti-gay slur. As the supervising physician, I made it clear that this was unacceptable. In general, with challenging patient behavior, I find it best to clearly lay out expectations and the consequences for violating them. So before talking to her, I discussed the situation with the nursing staff and hospital risk management, and we concluded that if she persisted in using this language, we would discharge her from the hospital, against her will if necessary.I made all this clear to the patient. Thankfully, she stopped and completed the rest of her hospital treatment. But if she had continued using racist and homophobic slurs, would I have been wrong to force her to leave the hospital? Although she was medically stable, and we would have sent her home with oral antibiotics, a discharge would have been substandard care: Had she been discharged and not sought care with IV antibiotics elsewhere, there is a very real possibility that she could have died from her infection.Is hate speech grounds for refusing medically necessary care? I was taught in medical school that physical violence against staff, or the credible threat of violence, is grounds for refusing care, whereas rude, insulting or mean behavior from a patient is not. Hate speech seems to me to fall between these two categories.Several Black nursing staff members felt strongly that this is what we needed to do, and I felt it was important to unequivocally support them. (I am a Hispanic, cisgender male.) But the patient had a substance-use disorder. This does not excuse her behavior, but it does put her in a more vulnerable category of patients. My assessment was that she was competent to make medical decisions, but I worry that her disease might have interfered with her ability to fully appreciate the consequences of her actions. Name WithheldThe responsibilities of clinicians should be configured in the light of the long experience of their professions. But these are social roles, and — given that we can all end up as patients, and we all contribute to the provision of health care resources — society has a part to play in determining what they should be. What we’ve decided is that the norms governing medical care are to be primarily concerned with the welfare of the sick. The workplace environment should minimize avoidable injury and insult to health care providers, but not at the expense of that basic aim.It was entirely proper to tell this patient to stop using racist or homophobic slurs — language that’s offensive whether or not it is addressed to those it derogates. And the Black members of your nursing staff justly value a workplace in which they are treated respectfully; that’s surely something every employee deserves. The question is what you should do when someone ignores this simple moral demand. And here your first consideration must be the risk to a patient of discharging her.Clinicians have duties of care to patients, even odious ones.This woman wasn’t in your hospital for some optional cosmetic procedure. She was being hospitalized for a possibly lethal condition, and as you say, discharging her meant providing her with substandard care. Had you done so, you would have violated a central ethic of your profession: that every life is of equal worth (even the lives of those who deny that tenet), that nobody should come to unnecessary harm owing to a caregiver’s decision.The reason you can discharge someone who poses a serious threat of violence to others in the facility is, roughly, that if we face a choice between seriously endangering Jamie and seriously endangering Alex, and Jamie is the source of the danger to Alex, we should prefer the threatened person to the threatener. We’re essentially choosing between bad medical outcomes; in a clinical setting, knives should be wielded only by surgeons. That wasn’t the situation you faced. Hate speech produces what some legal scholars would deem a “dignitary affront”; and a dignitary affront, however much we deplore it, is not a medical crisis. Your primary brief wasn’t to calibrate the harms done by hate speech to the climate of your workplace. It was to ensure your patient received appropriate care, whether in your hands or others’.Let me note, too, that the freight of words is affected by who’s speaking them. Patients — perhaps as a result of sepsis-associated delirium or certain neurological disorders — may not be in control of their speech; people who are subject to Tourette-syndrome-related coprolalia should not be denied medical treatment because their words make clinicians uncomfortable. And your patient? She had a problem with substance use and employed language that is, increasingly, stigmatizing of the user. She had no power over the clinicians who attended to her and to whose decisions she was subject. One indication of her lack of status is that your hospital’s risk managers evidently decided that the institution could safely eject her without being held accountable for the consequences. Though they didn’t intend to mete out a punishment that might have amounted to a death sentence, the risk managers effectively put the hospital ahead of the patient.The duties of medical professionals are demanding. In wartime, a medic can have the responsibility of saving the life of a wounded enemy soldier, even if the soldier has just killed one of that medic’s friends. The fundamental clinical imperatives — evolved, collectively, over generations — shouldn’t be hastily set aside. Clinicians have duties of care to patients, even odious ones. And the more serious the likely consequences of refusing care, the larger the burdens they should be willing to accept.My elderly mother began talking to a romance scammer on social media a few months ago. He claims to be building a bridge in South America and has asked her for money to support the project. She has given him tens of thousands of dollars — her entire savings. Given the convoluted stories she has told me, I have no doubt this man is scamming her, and she and I have fought about her continuing to talk to him. I love her, and it really upsets me that this man defrauded her of her money! Here is the thing, though. She talks to him via internet chat twice a day, and it genuinely makes her happy! She is the happiest I’ve seen her in a long time. She has had few friends over her life as well as disappointing romantic partners, and this is someone she actually enjoys talking to. Her savings are gone, and I think she will continue to use her Social Security and pension income to pay her bills. That is, I don’t think she will give this man much money in the future. Should I keep trying to persuade my mom to stop talking to this man, given that I think the “relationship” may end once the money flow stops, and she may feel very sad about the ending? Should I be worried about her physical safety if she stops giving this man money? Our arguments are really bad, and she definitely prefers I stop talking about it altogether. Name WithheldA lot has been published about romance scams, including by law enforcement, and I don’t see that, in the usual course of things, its victims are in physical danger — the scammers often live in another hemisphere, for one thing. (You could contact the F.B.I. if you want further guidance.) But the financial and the emotional depredations are very real. Once the money stops, naturally, the scammers move on. There will be heartbreak ahead for your mother.You’ve done what you can do. You have repeatedly pointed out the problem; you’ve warned her that the rewards of her relationship are predicated on a lie, and you no doubt have told her about the proliferation of such scams. She doesn’t want to go on talking about it. At this point, I don’t see what choice you have other than to let her be. As long as your mother remains competent, it’s up to her to manage her dealings with this man. There’s the minor solace that, as you indicate, the only ongoing risk is a continuing loss of relatively small sums of money, and she has enough to live on. It’s painful to watch someone you love being exploited, but you can’t lead her life for her.To submit a query: Send an email to ethicist@nytimes.com; or send mail to The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018. (Include a daytime phone number.) Kwame Anthony Appiah teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.”

The magazine’s Ethicist columnist on what we gain from making hard choices.My brother is 16 and lives with my parents. I am in my 30s and live several hours away. We have good relationships with one another, although my parents are extremely anti-Covid vaccine and anti-mask. They cannot be reasoned with over the issue.After the Delta surge died down, I went home to visit. My brother — who is no rebel — asked for my help to get vaccinated because my parents would not let him.I filled out the paperwork and accompanied him to the appointments as if I were his parent. This was illegal, but I thought it was the right thing to do. Although my brother is not legally an adult, he is competent to make this choice; if I had refused to help and my brother had become severely ill or died of Covid, I don’t know that I could have forgiven myself.My parents just found my brother’s vaccine card, and the truth came out. They blame me, and I am second-guessing myself. Did I do the right thing? I thought so at the time. I realize now I should have tried to talk to them first (even if it was impossible to convince them), and I should have come clean to my parents after the fact. I have broken their trust, and my father isn’t speaking to me now.Was I wrong? And more important, how do I fix this? Name Withheld, TexasThe philosopher Ruth Chang has a theory about “hard choices.” Hard choices, in her account, arise when your options aren’t equally good but none is better overall. They’re good and bad in different ways.You had sound reasons for making the choice you did. Your brother, you say, was competent to opt for vaccination, and in some states, he’d be legally entitled to. As his much older sibling, you rightly feel a special sense of responsibility when it comes to his care. The authorized Covid-19 vaccines are safe and effective at bringing down rates of infection and transmission and at significantly reducing the chance of serious illness. Your parents’ views on this topic are flatly wrong.To be sure, a 16-year-old with no special medical conditions isn’t likely to suffer severe illness from Covid; your concerns for his welfare may have been overblown. Still, he should have been allowed to get vaccinated, whether to protect others or to alleviate his anxiety about his own risks. In helping him to make this happen, you were doing something your parents should have been willing to do for him — and for themselves and their community.It’s when we are making hard choices that we become ‘the authors of our own lives.’Yet had you declined to help your brother get vaccinated, you would have been justified too. It’s certainly a problem that what you did violated a reasonable law issued by a legitimate authority. And it was disrespectful to your parents; you indeed betrayed their trust, in defying their strong (albeit misguided) wishes.To see it from your parents’ point of view, imagine that you have two kids. Your son wants to get treated by a traditional healer who serves a god your religion believes it is sinful to honor, and his big sister, who worships that god, too, arranges for this. She has provided a treatment for your son that served no purpose. Worse, she led him to betray his faith. It would be natural for you to feel resentment. The point is that for some people, opposing what we know to be sensible public-health measures is central to their identities, in the way religion can be. That’s deeply unfortunate. But it’s important in understanding your parents’ reaction. If you had helped your brother get a fake ID, I suspect, your father might have been mad, but you’d be back on speaking terms. In this instance, you showed not only that you disagreed with your parents about their views but also, more wounding, that you didn’t trust them to look after your brother — to fulfill the basic responsibilities of parenting.Many people are drawn to a bookkeeping model of morality: Tot up a row of numbers, determine whether there’s a plus or a minus in front of the sum and proceed with no regrets. Suppose that, owing to personal or public obligations, you have to tell a lie. The moral bookkeepers would assure you: The math works out, your conscience is clean, don’t give it a second thought. The greater wisdom is in both regretting the deception and understanding why it was justified. With hard choices, there’s no option that’s best in every way. We can, coherently, feel bad about actions we would not undo. It speaks well of you, as a loving child and as a caring sibling, that you’re uneasy. I can see why you didn’t simply start by trying to persuade your parents to let your brother get vaccinated. You’ve plainly had unrewarding conversations with them about these issues and found that they are firmly in the grip of their delusions. Telling them about your intentions in advance would have been respectful but surely futile; indeed, they may have taken steps to keep your brother out of your hands. Still, if you hadn’t had a conversation in advance, it would, I agree, have been more respectful to come clean once it was done. So tell your parents that you acted out of love and concern for your brother but that you understand and are sorry that you betrayed their trust. Of course, you’re sorry too that your parents have these gravely mistaken views — but you don’t need to say so, because they know it already. Often we face choices where we can reason our way to one clear answer. We can then say that we’re “complying” with what moral reason dictates. But sometimes complexity swamps compliance: We simply have to turn inward for guidance and own our decisions. In fact, Chang argues, it’s when we’re making hard choices that we become “the authors of our own lives.” We decide what we’re for — we decide who we are. Helping your younger brother get vaccinated and setting out to repair your relations with your parents aren’t self-canceling impulses; they’re self-defining ones.I’m writing from a nonprofit Zen center, technically a church in the eyes of the I.R.S. We’ve been holding monthly board meetings by Zoom, and one member has been attending in a state of inebriation. The meetings start midmorning and last up to two hours. During that time, the officer drinks from a cup, and her speech becomes increasingly slurred. All of the board members, including the officer in question, are members of our church, and all are highly regarded. Our ethics policy discourages intoxication at the center, but doesn’t refer to Zoom meetings.As a church, we are inclined to be as accepting as possible, but the behavior is disturbing. Her intoxication also causes her to become argumentative. On the other hand, isolating her, by removing her from the board, is not an appealing solution, and she does occasionally have good suggestions. Her term was recently renewed.All of us think that turning difficult members away is more harmful than keeping them close. And the situation is aggravated by the pandemic. We are meeting in person for meditation and services, but not for board meetings, and perhaps we ought to. How should we deal with this? Name WithheldThe issue isn’t so much whether this woman is keeping to the ethics rules as whether she’s OK, and plainly she isn’t. You’re not a canasta club; you’re a Zen center, one that’s presumably devoted to contemplative care and support for participants. It’s entirely appropriate for members to try to help a peer who has an unacknowledged difficulty. You’ll be doing her a favor if you can get her to recognize that she has a problem and that your community will support her if she sets herself on the path to recovery. Not that you’ll want to bring this up at a virtual board meeting. Taking her aside after an in-person one would be easier. And you don’t have to wait for an in-person board meeting if she’s coming to services and meditation. There are ways of raising the issue that are gentle, firm and loving. Her first reaction may be a mixture of embarrassment and denial, and it may take more than one conversation. But surely you believe that zazen is among the practices that can assist in the hard work of breaking an addiction. You’ll be helping your group by supporting a struggling member.Kwame Anthony Appiah teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to ethicist@nytimes.com; or send mail to The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018. (Include a daytime phone number.)

The magazine’s Ethicist columnist on marriage vows and stolen library books.What are your thoughts on the spouse of an early-onset Alzheimer’s patient dating while said patient is still alive? By way of background, my mother was the full-time caregiver of my stepfather until a few months ago, when he was moved to assisted living, and she is lonely and missing companionship. The man my mother has chosen to date is in his mid-70s (seven years older than my mother), has lost all his money, has three failed marriages and generally has a poor reputation. The way the news was broken to us children (two stepchildren, including me, and two biological children) could have been better, and we are worried our mother is acting out of fear of being alone.My siblings are hurt, angry and dealing with their father’s slowly dying, and it’s so hard to watch. My mother seems hellbent on dating this man and is not receptive to hearing our concerns. It was never going to be easy to see her with someone else this soon, but seeing her with this man is alarming. It’s also unlike her to be callous toward the feelings of her children. My fear is if we draw a line in the sand, she will pick him. But anything short of that seems as if it would be ineffective. Name WithheldTwo distinct problems are entangled here. On the one hand, there’s your sense that your mother is betraying your stepfather. On the other, there’s your worry that the person your mother is dating is bad news. Let’s start with the first, more ethically challenging, issue.Your feelings are entirely natural; early-onset Alzheimer’s often progresses especially fast, and at the stage it has clearly reached, it deprives us of the person we once knew and loved. There’s a special heartbreak that arises from the doubleness of someone’s being here but not here.It’s a loss that must hit everyone in your family in different ways. We talk of marital commitments as running “until death do us part.” We also know that many marriages end in divorce. Having a living, undivorced spouse who no longer recognizes you falls into neither category. Your stepfather did not break his vows or re-evaluate them. Nonetheless, he has effectively left the relationship — been removed from the relationship — in a permanent and irretrievable way. Your stepfather’s advanced dementia has, in short, robbed your mother of her husband..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}The painful truth is that her status is ethically equivalent to that of a widow.Making sure that a spouse is cared for is one commitment that marriage entails and, having served as a full-time caregiver, your mother has clearly done so, at real personal sacrifice. But we should not want our spouses to abjure the companionship of others once we are no longer available to them. Indeed, nobody in your family has the right to expect this of her. The painful truth is that her status is ethically equivalent to that of a widow.As for the very different worry that your mother’s beau is going to let her down: I agree that his track record is worrisome, and given his situation, one could wonder whether there’s a financial aspect to his interest in her. If you believe she’s at risk here, you should try to persuade her to be cautious. Yet that will be especially hard if she thinks you’re really motivated not by concern for her but by loyalty to your stepfather.That’s why you should do your best to work through your feelings and get your motives clear before you start. Then you can tell your mother that you are happy that she has found companionship but that you hope she has thought about what her new partner’s history means for the prospects for their relationship. Whether she takes any notice is, of course, for her to decide. But this doesn’t mean that those who love her shouldn’t offer their advice.When I was a child, my parents had some huge fights about some books my dad stole from the marvelous library of the university he attended on the G.I. Bill. They were 10 bound volumes of Harper’s Bazaar from the 19th century. Growing up, I pored through all of them and found them fascinating. My dad died when I was 20, so I finally broached with my mom the idea of returning the books. She did her purse-mouthed thing and said, “I’ll think about it,” which was her standard way of not dealing with something. I tried talking to her about it several times over the years and realized she was afraid of it reflecting badly on her, because she hadn’t persuaded him not to keep them.My mother died four years ago, and I told my sister I wanted to return the volumes. She lives in Mom’s house and so has physical control of them. She insists that Dad told her that he was awarded them for an essay he wrote. I don’t doubt Dad told her this, but she won’t recognize it was a lie. I have pointed out to her that the volumes are not sequential, which makes no sense for such an award. I told her my memories of the fights our parents had about it, and she refuses to believe me.I feel this great guilt that those books, which could help someone’s scholarly research, are just sitting on a shelf. I don’t know whether I should do something or just let it go. Name WithheldThe theft of shared property — a category that includes library books — is particularly unfortunate. It can leave a whole community worse off. So I understand your sense of guilt. It must be galling, too, that your sister refuses to face the awkward truth and resists your decent impulse to get these things back where they belong. There’s a lesson here about the human tendency to align what we think to be true with what we’d like to be true. We may balk at replacing an enchanting story about a prizewinning essay with a disenchanting one about library larceny. Our cherished lies will not bend to new evidence; we bind them with hard covers.Still, you may find some reassurance in the fact that the complete run of this magazine is digitally available in many libraries, almost certainly including the one you mention. (I just looked at the first issue, which appeared in 1867, through the library website of the university where I teach. It bills itself “A repository of fashion, pleasure and instruction” — rather like my classroom when filled with students.) And scholars who need access to the actual pages can locate physical copies in storage somewhere. Another awkward truth: Libraries have often selected bound periodicals like these for deaccessioning, a process that sometimes ends in their destruction. You can’t be confident that the library would even accept their return.Kwame Anthony Appiah teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to ethicist@nytimes.com; or send mail to The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018. (Include a daytime phone number.)

The magazine’s Ethicist columnist on mitigating risk from Covid-19 without punitive measures —and more.I’m a family physician in private practice. More than 225 of my patients have been infected with the coronavirus. Some were hospitalized, some were placed on ventilators and more than a few have “long Covid” symptoms. When the vaccines became available, not only did I and my staff get vaccinated, but we also assisted our patients in procuring vaccination appointments. By spring, more than 80 percent of my patients were fully vaccinated, and we can now offer unvaccinated patients the convenience of vaccination in our office. A significant segment of our practice consists not of “vaccine hesitant” but of “vaccine refusing.” We attempt to create a nonjudgmental, nonshaming atmosphere for our patients to express their reasons for refusing the vaccine. Many have bizarre, almost delusional reasons for not getting vaccinated. Others have fallen prey to misinformation online. Because our patients often take mass transit to their appointments and because our office is in a high-rise and because I offer telehealth appointments, is it ethical and in the interest of public health to restrict vaccine-refusing patients to telehealth appointments? Name Withheld, New YorkWe all depend on other people — our trusted networks — for much of what we know or believe to be true. So we’re all vulnerable to misinformation when people whose epistemic authority we trust mislead us. Sometimes, no doubt, a touch of arrogance eases the departure from reality, too. Lay people who dissent from the scientific consensus may strike you as woefully credulous but often pride themselves on being independent-minded. Still, these are social, not individual, delusions.And social delusions pose shared difficulties. Commendably, it sounds as if you’ve done your best to set everyone straight. Once certain patients are committed to nonvaccination, however, you are not free to make decisions that could reasonably be viewed as punitive. You can certainly insist on their keeping away from the premises if they pose a genuine risk to others in your practice. But that shouldn’t be the case, given that your patients are mostly vaccinated (and your staff entirely so) and that you’ll presumably require unvaccinated patients to wear masks and practice social distancing.When unvaccinated patients ask for an appointment, you can routinely offer teleconsultations (in circumstances where this is a medically sound option), explaining that, in your view, every trip puts them at further risk of contracting or transmitting infection. That’s a good way of keeping before them the fact that a relevant expert in their lives has a different view from theirs. Still, these exasperating people should be free to ignore your very sound advice and remain in your care.My adult son told me he was “waiting his turn” to be vaccinated but now admits he has no plans to do so. He is in his 30s and steeped in conservative media messages, like Fox News and Dave Ramsey. He says as long as we are vaccinated, it doesn’t matter if he isn’t. We feel that he’s taking a belligerent and selfish stance. We believe that the vaccine is important not only for each recipient’s own health but also to protect people who can’t take the shots (and the vaccine is not 100 percent effective). Logically, we know he’s unlikely to infect us. We’re scheduled to meet for a small celebration. Our first reaction was to continue our “no mask, no meet” policy, but are we overreacting? We could still meet, but we would wear masks. This will cause a deep rift if we don’t handle it well. Name WithheldTo go by current C.D.C. guidance for small indoor gatherings, your son is the one who should be masked. But if he’s the only unvaccinated participant, the risks to you — and to him — are very low. (New variants could change the calculation; we’re getting additional data all the time.) Yes, he’s being a knucklehead in this respect, and I trust you’ve made your views about it very clear to him. But a family celebration isn’t a favor to which you can attach conditions. The prospect of getting together, even with this blinkered soul, is something you plainly value. You probably won’t go wrong by suspending the policy and letting him raise a glass with you.My 11-year-old son is very nervous about being out in the world. My wife and I and our 13-year-old are all vaccinated. I would like our 11-year-old to get vaccinated and am willing to lie about his age to do so. (I am confident that if the vaccine is fine for someone a few months older than he, it’s fine for him too.) Is it ethical to sign him up for a vaccine and to ask him to lie if asked about his age? Peter, Iowa CityThe rules and recommendations of medical authorities rightly shift in response to shifting evidence; they shouldn’t be bent in response to our individual fears.Most of the time, the social logic of vaccination has a pleasing symmetry: It’s good for you, and it’s good for the rest of us. With children, who can transmit the virus but very seldom get seriously ill from it — and again, new variants could change the picture — the benefits flow mostly to others. As this newspaper has reported, children your son’s age are more likely to perish from flu, drowning or motor-vehicle accidents. Look for ways to reassure your boy that don’t involve a needle. The rules and recommendations of medical authorities rightly shift in response to shifting evidence; they shouldn’t be bent in response to our individual fears.I retired as a professor of education from a small college. One of my former colleagues in the department had only a master’s, for which the department was criticized by an accreditation agency. She applied to a Ph.D. program a few years ago but was not accepted and left the college. She is now working as an administrator in a private school for children with disabilities. A short bio on the school website states that she received her Ph.D. from a Midwestern university in 2012. I know that to be false, as she was rejected from a local program after that date.My first impulse was to contact the private school. On reflection, however, I realized that this would result in her losing her job. Do I have a professional obligation to let the school know that her bio is not accurate? Robert Berman, Long Island, N.Y.Your former colleague wronged her employers when she deceived them; she may have wronged others who competed with her for the job. But yes, taking an action that would have grave consequences requires careful consideration. Being fired is a serious penalty for this lie, especially if, as I suspect, the qualification she claimed wasn’t really necessary for the job. Had the school truly cared about the credential, it could have done its due diligence: Degrees are considered “directory information,” readily disclosed to potential employers.We regularly put too much stock in formal qualifications: If she was doing a good job in your department, your accreditors were taking a shortcut to a proper evaluation. Having a doctoral degree cannot matter more than experience and commitment in teaching. (And I’m putting aside the fact that plenty of people with doctoral degrees are lousy teachers.) In the British system of higher education in which I was formed, the doctorate arrived as a belated German import, and many eminences on the faculty wouldn’t have had one. What’s more, your colleague is working now as an administrator in a pre-college context, and teachers and administrators without doctoral degrees have been responsible for great K-12 schooling, including for students with disabilities. I would feel different if I thought her prevarication was at the expense of those children, but I see no reason this would have to be so.None of this is at all exculpatory. That our preoccupation with paper credentials is regrettable doesn’t excuse a misrepresentation of those credentials. So let me be clear: You’re certainly entitled to expose her and wouldn’t be wronging her if you did. The loss of her job, perhaps of her career, would have been her own fault. But you don’t have a professional obligation to expose her, either. Keeping other people honest about their credentials whenever we happen to find them misstated isn’t a duty we have in relation to everyone we’ve ever worked with.Kwame Anthony Appiah teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to ethicist@nytimes.com; or send mail to The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018. (Include a daytime phone number.)

The magazine’s Ethicist columnist on the obligations faced by those who choose not to be vaccinated against Covid-19.I run a small group at a college that requires Covid-19 vaccination for students. One student in my group received a religious exemption. I want to start having in-person meetings and functions, but not everyone is comfortable gathering in a room with an unvaccinated person. Even though the risk is small to any one of us because we are vaccinated, some of us have family members who are unable to be vaccinated at the present time. Having an unvaccinated member within the group carries a risk that one of us could become infected and infect an immune-compromised person or otherwise vulnerable family member.Group functions and meetings are vital to my students and especially to new members. They promote learning and exchange of ideas vital to our projects, and social and work-related interactions are important for our work and for team building. Before Covid-19, we would order food and discuss work-related issues and other topics. The Zoom meetings we’ve been having are not a great substitute for this. How can we have group functions and not exclude an unvaccinated person? Should we suggest that the person participate via Zoom? Name WithheldPeople are free to refuse vaccination for religious reasons, but they may have to deal with the consequences. The fact that most students in your group have been vaccinated substantially lowers their risk of contracting the virus and then infecting other, vulnerable people, but of course not to zero.The C.D.C. currently uses red (least safe), yellow (less safe) and green (safest) scoring to indicate safety when vaccinated and unvaccinated people mingle. There are certainly ways of accommodating this unvaccinated student that would secure a fully green score for all participants — meetings with masks and social distancing and without food; or meeting only outside. But such measures would pose a serious burden. They would impede the easy, free-form interactions that contribute to the group’s functioning. The unvaccinated student who wishes to be included in these interactions, meanwhile, gains nothing when they are eliminated for everyone.The members of your group could reasonably agree to gather in a room with an unvaccinated person who was properly masked and distanced. (Note that it’s the unvaccinated person who is chiefly at risk, earning a C.D.C. “yellow” even when those precautions are taken.) Otherwise, the student could indeed participate via Zoom. This arrangement is far from ideal. The student will not get all the benefits that other members will. But disallowing this student from pre-pandemic-style in-person sessions where everyone, including the student, is unmasked and undistanced wouldn’t represent hostility toward the student or his faith community. It would merely represent C.D.C.-guided vigilance.For years I have employed a lovely young woman to clean my home. She also works for several of my friends who, like me, are elderly with various infirmities. For five months, at the height of the pandemic, I asked her not to come to work but paid her nevertheless. Now she says that she does not plan to be vaccinated as she doesn’t think she needs to be. I said that I might ask her to stop coming when it is cold outside and I cannot leave my home while she is here. I told her that I would be unable to pay her in that event. I believe this would be her choice. She appeared upset but did not say she would reconsider. If she later tells me that she has been vaccinated, would it be ethical for me to ask to see her vaccination card? Name WithheldAsking her for evidence of vaccination means you don’t take her at her word. That reflects, of course, the strained nature of your relationship. But she either doesn’t recognize that her vaccination status matters to you and her other elderly clients or is reluctant to be vaccinated for reasons that go beyond doubting that “she needs to.” Otherwise she would have volunteered to be vaccinated once you voiced your concerns. In paying her not to work for five months, you’ve properly shown consideration for the exigencies of people in her position. But there are exigencies for people in your position, too.Once again, it’s up to her whether she chooses to forgo vaccination, but it’s also up to her to deal with the consequences. She may prefer not to; she may think that lying about her vaccination status is justified because it’s not your business. But it is. And if asking for evidence of vaccination will secure your peace of mind, you’re entitled to do so.I recently discovered that my sister lied to our elderly parents about being vaccinated for Covid-19. She has no plans to get vaccinated and told them she had done so only to allay their anxieties. Of all my siblings, she has the most direct contact with our parents.I am not close with her and was stunned when, in a rare conversation, she divulged what she’d done. Our parents have been diligent about masking, distancing and getting vaccinated. When they believed she’d been vaccinated, they allowed her back into their home, unmasked. They are now making summer vacation plans that include her and involve staying together. My sister’s omission has put me in an awkward position. Covid-19 is a dangerous and deadly disease, especially for people over 60. The vaccines are not 100 percent effective. Our parents have a right to know the vaccination status of those with whom they spend time indoors, unmasked.What’s the best way for me to approach this? Should I insist my sister tell them the truth and give her a small time frame to do so, before I tell them myself? Name WithheldIt sounds as if your sister, too, has neglected to consider how her decision affects others — unless, of course, she simply doesn’t care. Your parents, given their age, have an increased risk of “breakthrough infections,” and they have let their guard down with your sister because she lied to them. Call your parents now. The only call you should consider making before you do is to your sister, telling her what you’re doing and why.I live in an apartment, and my next-door neighbor recently died of Covid-19. We shared a patio area with him for five years, and he was friendly when we ran into each other, which wasn’t very often. Most of the time, he was at his partner’s house across town. I found out that my neighbor had died when his children started coming in and out of the apartment. They seemed not very emotional, more focused on divvying up his belongings.I later found out from the partner that she had been removed from the hospital visitation list by the children and wasn’t allowed to say goodbye during his last days. She asked my husband and me to write a letter verifying their relationship, to use as legal evidence of their domestic partnership. She would like to win back the apartment and possibly some belongings.I didn’t know much about her or the history of her relationship with our neighbor. I don’t doubt they were committed to each other, but I’m not sure we are the best people to write letters of support. She has been spending time in the apartment, and we hear her crying loudly. Should we write the letter or stay out of it? Name WithheldI assume you think your neighbor would have wanted some of his possessions to go to his partner, even though he plainly failed to document those intentions. If they were a couple, especially a longstanding one, she has a moral claim to some of the property they shared; a court can decide whether she has a legal one too. Because you seem to have relevant evidence, it would be a good thing to provide it.But you have a duty to say only what you are confident of. You may not ornament the truth in order to advance her interests, however much you disapprove of these children. In the meantime, you might spread the word to friends and acquaintances about the merits of having an up-to-date will.Kwame Anthony Appiah teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to ethicist@nytimes.com; or send mail to The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018. (Include a daytime phone number.)

The magazine’s Ethicist columnist on balancing health care providers’ privacy against patients’ concerns, creating an equitable vaccine system and more.I was planning to make an appointment with a hygienist working under my dentist and was told by a third party that one of the hygienists had contracted Covid, been treated and was back to work. I am 69, and my nephew died of Covid last May. Four other relatives contracted the virus and recovered. I am nervous about the pandemic.I requested not to be treated by that hygienist and received this email in response: “To protect the privacy of our staff, just as we do for our patients, we cannot confirm or deny if someone has recovered from the coronavirus. This would be a violation of HIPAA. Your request to not be seen by someone who tested Covid-19 positive was not appropriate, as C.D.C. guidelines state that after 14 days of quarantine, individuals are safe to go out in public. In addition, our clinicians wear appropriate P.P.E. for treatment (including N95 masks, face shields, gowns, gloves), and our office has implemented additional infection-control measures. We monitor for symptoms, take temperatures and measure oxygen saturation daily for everyone that comes into our suite. If this policy makes you uncomfortable, our office may not be a good fit for you.”I have a problem with putting the privacy of an employee ahead of the concerns of a patient. I also thought that HIPAA applied only to disclosures by a doctor about their patients. Am I out of line to make this request? Should a doctor or dentist tell patients if a staff member has had the virus so that the patient can make an informed decision about treatment? Jack L. Schwartz, Los AngelesAll employers, including medical employers like your dentist, are entitled to have certain kinds of health information about employees. But, like health care providers, they should generally keep that information confidential. It’s granted to them for a limited class of purposes and should be seen only by people who require access to it for those reasons. (The federal rules are complicated, but the basic idea is that information about people’s health shouldn’t be given without their consent unless necessary.) Your dentist is entitled to know that employees are sick in order to confirm that they have medical reasons for taking sick days and to be sure that they pose no risks when they return to patient care. But precisely because the dentist was allowed the information necessary to decide whether the hygienist could safely be at work, patients in the clinic don’t need this information.The really important thing isn’t whether someone once had the virus but whether everyone in the clinic is taking the appropriate precautions with respect to hygiene and P.P.E. As it happens, people who have recovered from Covid-19 are thought to have immunity to it for some time, and people who have immunity to the virus are less likely to transmit it. So it doesn’t make sense to avoid a hygienist who has recovered. Someone who has never had the disease or has not been vaccinated poses the greater risk. (Though, again, a minimal one given proper precautions.)The C.D.C. says that someone who has had Covid-19 can be around others if 10 days have elapsed since symptoms began, a full day has elapsed without fever and other symptoms are improving. Although your dentist’s précis was inexact, it sounds as if the office erred on the side of safety and is rigorous about protocols. Your dentist was making the point that there was no clash here between employee privacy and the legitimate concerns of a patient. Possibly, though, I wouldn’t have added that slightly barbed final comment (“If this policy makes you uncomfortable, our office may not be a good fit for you”). Dentists, of all people, should understand the power and prevalence of irrational anxieties, and one element of good medicine is an understanding heart.I am a college student who spent my break working as an E.M.T. for a private ambulance service. My state’s Covid-19 vaccine protocol prioritizes first responders, and I have the option to receive a shot next week. Given that it can take up to a few weeks for the vaccine to promote antibodies, however, if I get the vaccine now, it won’t protect me until after I’m back at school. My early vaccination provides no benefit to the community, and I could be taking a dose from someone who is at greater risk. Is it wrong for me to get the vaccine knowing that if it weren’t for a few weeks of work, I would be waiting months? Elizabeth Hopkinson, MassachusettsA fair and reasonable system that isn’t unworkably complicated will end up vaccinating some people earlier than others whose need is greater. It’s not your job to add further criteria of your own. What’s more, the available evidence suggests that significant protection starts to kick in about 10 to 14 days after initial vaccination, which could overlap with your period of work as an E.M.T. And being vaccinated does provide a benefit to your community. It lowers the chance of your transmitting the disease by reducing the likelihood that you’ll contract it and, very likely, by reducing the likelihood that you’ll transmit it even if you do. Adding to the overall vaccination rate, which this does, will be necessary in order to reach something like herd immunity.An acquaintance asked me to refer him for an open position at my company. Normally, I would be happy to do so, but he mentioned that for New Year’s he rented a house in another state with a group of friends and later traveled to yet another state to ski. I think it is irresponsible of him to have engaged in recreational travel during the winter peak of the pandemic. The position he’s applying for is at a company where all employees currently work remotely. My concern is not that he’ll get anyone sick but that his recent travel indicates poor judgment, which may be obliquely relevant to his ability to do the job. Should I decline to refer him on these grounds or is that too big of a logical leap? Name WithheldYou’re not obliged to recommend an acquaintance for a job just because he asks. And if you do, you should not hide faults relevant to that job. But your resistance to recommending this person doesn’t seem to be that you think he wouldn’t do a good job; it’s that you disapprove of his behavior during the pandemic.As an empirical matter, though, there’s reason to doubt that people’s character traits are “global” — that the careful accountant is a careful driver, that the faithless spouse is a disloyal friend, that the effective product manager will share your sensible concerns about unnecessary travel and socializing. So yes, that’s a big logical leap.Still, you’re entitled to decline to recommend him because you think that he failed to display a concern for the common good; as an ethical matter, you can deny a favor to someone who, in your view, lacks an important virtue. What you can’t do is say you’ll recommend him and then not do so.I’m in a high-risk group, eligible for a Covid vaccination in both the state I live in and a neighboring state. My state is doing a poor job of distributing vaccines, and I’ve failed to get an appointment. But the neighboring state has a terrific system. A friend who lives there got me an appointment. I know that they don’t ask for your address when you arrive for your appointment, which suggests that they’re not overly concerned about residency, and my friend didn’t misrepresent me when signing me up. Am I right to feel a twinge of guilt all the same? Name WithheldDifferent states have different approaches. Our collective goal, as a nation, is to get as many people vaccinated — especially those at particular risk — as quickly as we can. But because states are allocated vaccines on the basis of their population, some are taking a firm line, restricting vaccinations to those who live or work there; they may require documentation or at least self-attestation to this effect. Other state officials seem OK with letting visitors in the line. So long as you don’t misrepresent yourself at any point, you can proceed with an easy conscience.Kwame Anthony Appiah teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to ethicist@nytimes.com; or send mail to The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018. (Include a daytime phone number.)