50+ Lifestyles

Your Advocacy Connection

By Jamie Long, Chief Patient Advocate
GolderCare Solutions, Unlimited, LLC

Sometimes Your Only Choice is the Lesser of Evils

You’ve been there before. We’ve all had to face it from time to time in life, particularly so in caregiving.

It’s a classic situation. You suddenly realize there is simply no ‘right’ choice. No single choice is all good or ‘righteous.’ The only available choices all involve some amount of ‘evil’ or wrongdoing. You’ve got to choose between 2 or more evils.

It’s distasteful and it’s scary. Many of us who care for the aged and the disabled have to confront this dilemma more often than we’d care to admit. It tends to be even more frequent for caregivers who have to deal with dementia victims.

“Should I tell Mom?” It’s one of the most common questions we get.

“Well,” we start out, “that depends. We can’t make the decision for you. You know Mom far better than we do.”

We then go on to explain that it may boil down to choosing the lesser of evils.

The first evil: not leveling with Mom. When you’re acting for someone else or making decisions on their behalf, it’s always a positive evil to withhold the truth. Lying to Mom or withholding material information from her is generally a bad thing. There isn’t much question about that.

The second evil: burdening someone with information they can’t handle, either intellectually or emotionally. Certain information may, under some circumstances, be considered hurtful, or even cruel.

So, what happens, for example, when Mom becomes insistent during your visit that you take her home from the memory care unit in which you are visiting her?

Do you answer truthfully? “No, Mom. I’m sorry, but we both know that’s not possible because of your poor memory. You can’t take care of yourself well enough to stay at home alone.”

Or do you affirm and divert? “I’d love for you to be back home. We’re working in that direction. But first, we’ve got to get ourselves a snack so we don’t get hungry. Let’s go to the snack bar right now.”

‘Affirm and Divert’ is the name of the suggested protocol for dealing with dementia patients who can no longer handle the first answer. Perhaps Mom finds that answer emotionally overwhelming and is likely to become distraught at being told she can’t go home. Or, perhaps, she has reached that point in her dementia journey when she can no longer handle being contradicted and reacts to being told “no” argumentatively or, even, combatively.

Additionally, do you tell Mom EVERYTHING or will that be a burden to her? Do you tell her you are liquidating an investment to use for her care? The choice between full and complete disclosure or not burdening her with things that may bring her distress is a difficult choice

There’s no singularly right or wrong answer in these conundrums. You, as Mom’s caretaker, will have to play it by ear and determine for Mom and yourself the lesser of evils at each point along her, and your, care journey together.

Jamie Long is the Owner and Chief Patient Advocate for GolderCare Solutions Unlimited and bring his many years
of experience to continue to advocate for seniors and the disabled.