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Extra-Marital Sex: Spouse of the Demented Marital Partner
Without additional discussion by me, I would like to pose a question to my visitors. There is a husband or wife of a severely demented (institutionalized Alzheimer's) patient who asks the doctor whether it would be the ethically right thing to do to engage now in extra-marital sex. What should be the doctor's response? Or what should the doctor find out before responding? ..Maurice.
20 Comments:
While I personally can’t speak towards the MD viewpoint I would have thought that would be outside a doctor’s purview. Surely this would be a personal decision for the effected individual based on their own moral code/ethics?
Believe it or not, actually it is not unusual for a patient or family member who have developed a trusting relationship with their family physician to ask their doctor a question related to their own personal behavior, something that one, perhaps even the physician, might think that the individual would or should decide by themselves. But, if you were the doctor and you decided to respond... based on your own moral or ethical or humanistic views, would there be anything further to find out from this spouse or what might be your response? ..Maurice.
I think the first question that immediately pops up in my head is "how much do you love your spouse". And I guess if the person loves his/her partner to the "threshold" level then abstinence would not be as difficult as it seems. (IMHO)
O.B.J
O.B.J., you are using the expression "threshold level" quantitating the love of a spouse and I must admit I don't understand what you mean. It would appear that abstinence from sex is not what the spouse was desiring as described in that one line scenario. ..Maurice.
I'm an oncologist and a hospice medical director.
I tell the families of my patients that their presence and caring does more for the patient than anything that I do.
Even the far demented (FAST 7E for the knowledgeable) will be aware of a spouse although they may no longer respond. And the principle nature of that awareness dill be it's feeling and emotional content. And if you're cheating they'll probably know somethings the matter.
I don't tell people they can't or shouldn't or that it's bad or even wrong.
They should decide whats best for them. I can't make that decision won't give an opinion or advise any action or inaction.
But there will likely be some sort or impact on the patient.
If a patient has developed that sort of trust relationship with his or her family physician whereby he feels comfortable seeking the advice of his physician in such a personal matter, there are several ethical considerations. First and foremost, I would take into consideration the person's spiritual/religious background. I think that if I've built that level of trust with them, I'd at least be knowledgeable to a degree about the person's ethical/moral background. If our relationship is close, I would offer my own personal opinion on what I would do given his situation. I would contend that when vows were exchanged for marriage, you vowed "till death do us part". Ultimately, engaging in behavior that you know your spouse will disagree with or disapprove is morally and ethically wrong, given the fact that it's a violation of the solemn committment you made to your partner years before. Unless the partner specified that extra marital sex was permissible should anything like this happen, I would advise him that it's both morally and ethically wrong.
It shouldn't change your view, Onyinye, but in the scenario I presented, the one asking the physician was not the patient but the healthy spouse.
You wrote:" If our relationship is close, I would offer my own personal opinion on what I would do given his situation." But that is it: should the doctor present to the questioning spouse the ethical consensus (if there is any) and pertinent law (if there is any) and not the doctor's own personal moral or religious rationale? ..Maurice.
I would use caution advising anyone (let alone a spouse in that vulnerable of an emotional position) as to the appropriate or ethically moral time to have an extra-marital affair.
If they need permission or validation from any source, then this is certainly not an appropriate time. They are obviously still struggling with the suitability of the affair, and the resulting guilt of such a miss-step could tragically ruin whatever quality of time they have left with their ill spouse.
Right or wrong to have the affair? It is just not a position someone should be putting you in, because the ramifications will not be shared by you and them….but rather: by them alone. If they are ready to accept the heartache with the ‘joy’ of an affair, then they should be ready to make that very adult decision without your opinion.
Personally? I would tell them this is not appropriate. This is not a relationship that has a great deal of time to wade through the turmoil of guilt and forgiveness. This is not a relationship that can give the ill spouse the respect of honesty that we all deserve. These are, after all, the exact times that we count on our loved ones to be decent and respectful enough not to show us such humiliation. These are the times we cannot see how others treat us.
Integrity is doing the right thing when no one is watching.
Suzy/swf
Suzy, do you want me as the family physician of both the demented wife and the husband, to answer the husband's request with:" this is not appropriate. This is not a relationship that has a great deal of time to wade through the turmoil of guilt and forgiveness. This is not a relationship that can give the ill spouse the respect of honesty that we all deserve. These are, after all, the exact times that we count on our loved ones to be decent and respectful enough not to show us such humiliation. These are the times we cannot see how others treat us.Integrity is doing the right thing when no one is watching." You really want me to give the husband, as their physician, a moral lecture? How about me simply referring him to his religious counselor? ..Maurice.
No Dr. Bernstein. I said "I would use caution advising anyone (let alone a spouse in that vulnerable of an emotional position) as to the appropriate or ethically moral time to have an extra-marital affair." and "Right or wrong to have the affair? It is just not a position someone should be putting you in".
That would be my overall feeling about your role in this matter. My point was using caution as to whether you should be entering into this matter at all.
It would obviously be easier to
just refer them to a religious advisor and/or councilor, but then: what would be the point of asking the ethical question here?
But as for me "personally" (and you did ask "But, if you were the doctor and you decided to respond... based on your own moral or ethical or humanistic views" ...
I gave "my" opinion, and yes, that is my own moral or ethical or humanistic view.
There is nothing more final than how you treat a dying loved one. And quite frankly, she deserves someone's support and consideration.
Suzy/swf
Suzy, one could argue that a physician would be ignoring his or her professional duty by ignoring the husband's question or avoid to suggest an answer but instead suggests that the husband check with someone else. ..Maurice.
One might say that, but is it true. Is it your professional "duty" to act as moral compass within a couple's relationship? Some may want it. Some may even expect it. But that does not make it your professional duty.
The wife ( as I understand?) is your patient as well. Stepping into this can (in effect) make you her surrogate spokesperson. Unless you have spoken to her about this, and been given permission to speak on her behalf, then how are you to know what she would want or expect from her husband?
The truth is you probably could not know, so how could you guide one patient in or out of the direction of cheating on the other?
Suzy/swf
Suzy, sometimes it is necessary for the family doctor to make decision advice to one spouse without consultation with the other on issues that can affect both. For one example that quickly comes to mind is the advice to the male patient who was found to be HIV positive to notify his wife regarding the positive test so that she can know what has happened and can, herself, be tested for HIV infection. In this case, the doctor has presented a hopefully emphatic advice to the husband without, of course, personally contacting the wife regarding "whether or not she would want to know". ..Maurice.
That is still health advice Dr. Bernstien: well within your professional duty.
Perhaps a closer analogy would be that the wife found out that the husband is HIV positive and she appears to be healthy. She tells you she still has sexual needs but does not want to risk sex with her husband...so is this an "appropriate or ethically moral time to have an extra-marital affair"?
Would advice change if it were two, or four, or six affairs? Where might that moral compass fall?
Safe? Perhaps to that you have advice. Morally ethical? How are you to know?
Suzy/swf
Suzy, of course you are correct, my example was health and not moral advice. Actually, your scenario is much more complicated than the scenario with which I started this thread. In my scenario, the ill spouse may be mentally incapable of detecting what is going on in the sexual life of the healthy spouse. In your story, your healthy wife must deal with a mentally healthy husband and so my reaction to the wife would be "let me refer you to a marriage counselor, it is possible that you may need one."
A little sarcastic? But, also, maybe a realistic answer for a physician in that situation. ..Maurice.
Perhaps the physician might act as a psychologist might - explore the healthy spouse's feelings about the matter. And perhaps, even ask "What do you think your spouse would want you to do?".
The reason I suggest asking what the demented spouse might want is - Personally, if I was the severely demented one, I'd hope that my spouse would remain loyal enough to visit me. However, I would want him to be happy, and would also hope that he would find a full and rewarding relationship with someone else. As I would be unable to provide such a relationship, why should my spouse have to suffer? And I would not know, so would not be harmed.
TAM
Sounds like "Jane Eyre" although Mr. Rochester kept his demented wife in the attic. I might recommend watching that movie again as it illustrates the difficulties and emotions associated with such a dilemma.
This issue is one that would be better discussed with a clergy if the persons involved have any religious views. Their marriage vows may have been "in sickness and in health" and going against a commitment and promise made could cause some emotional and spiritual distress after the physical needs are met. Still, our culture endorses situational ethics and most people would advise that "if you can't be with the one you love, love the one you're with." I am still not sure that the fallout from this would warrant jumping into a extra-marital sexual relationship.
Charlotte, you wrote "This issue is one that would be better discussed with a clergy.." Well, the visitors here on this topic might be interested to read a recent article in the Los Angeles Times. The following are excerpts from the article:
" Pat Robertson has made many controversial statements over the years, such as suggesting that the Sept. 11 terrorist attacks were God's punishment for the U.S. tolerating abortion and homosexuality. His critics are usually those on the politically opposite spectrum of the conservative Christian leader, or outside the Christian faith.
But the television evangelist's most recent statements -- condoning divorce when a spouse has Alzheimer's -- appears to have offended many Christians who feel it violates the sanctity of marriage and that most cherished of marriage vows: Til death do us part."
"His comments came in response to a caller who said that a friend had begun dating other women while his wife lies seriously ill with Alzheimer's, and justifies it by saying that 'his wife, as he knows her, is gone.'"
Can one equate, from a marriage vow point of view that advanced Alzheimer's could represent death? ..Maurice.
This is an interesting dilemma because I really don't think there is one "right" answer. I think it is very important that the doctor not give the spouse a clear yes or no answer on this.
I think the best anyone can do is help the spouse sort it out. Are they asking because they are looking for permission to do something they really think they should not do? To me, the question revolves around doing one's best to act in ways that leave him/her with no regrets over time. Those potential regrets can come in more than just the immediate moral issues. Does the person have relationships with children or extended family that will be permanently damaged by an affair? Might they want to keep those relationships and any associated support during the spouse's illness and beyond? Given the person's values, would this haunt him/her over time? (It is easy say you don't know how you will feel later, but I don't believe that in the case with something this big.) Maybe a referral to a support group for spouses of people in similar situations would be appropriate.
I keep coming back to wanting to help the spouse think this through without giving advice. The moment that is done, the doctor (or advising person) can be blamed for a decision that can only be made by the spouse.
AB
Wow. A highly intellectual and detached discussion of ethics. Different view here. People get divorced everyday, and 'Till Death do us Part' doesn't get mentioned, ethics do not get mentioned and little in the way of judgement is offered. How is this so different? Clearly the people who commented are not dealing with a demented spouse. The correct answer is,
'You need to do what is best for you and only you can know what that is.' Followed by an open and non judgmental discussion of what the spouse is thinking.
What is missing for the spouse is the significant other they used to discuss things with, which is why they are asking such a personal question of a health care provider. As a rule a health care provider does not have time for this which is why you are looking for the short answer but there isn't one. A counselor is better, so refer them. This is a personal, private and painful issue that requires time and sensitivity.
JJJ
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