Stoic advice: my parents are elderly and losing their autonomy

[To submit a question to the Stoic advice column send an email to massimo at howtobeastoic dot org. Please consider that the column has become very popular and there now is a backlog of submitted questions, it may take me some time to get to yours. Apologies.]

J. writes: “I’m nearing fifty and my parents are around eighty (Mom is 78, Dad is 81) and they are starting to fall apart. My mom is seeing neuro-doctors for a sudden onset of memory loss. Not sure it’s Alzheimer’s but it’s not good and it’s getting worse. My dad is a Type II diabetic and as careful as he tries to be he periodically has highly fluctuating sugar numbers and while my wife, daughter and I were there visiting them this past weekend he crashed and we had to call paramedics to work on him and revive him in the middle of the night. It’s happened before but in the past if he ended up needing help or even had to go to the hospital for a while my mom could help him out or drive to visit him. Now it is impossible for her to drive and I believe if we hadn’t been there and the paramedics had taken him to the hospital it wouldn’t have been safe for her to stay home alone.”

“She realizes their predicament and is willing to move. I have gotten my father as far as visiting a couple of recommended retirement homes that he seemed to like, but he keeps putting off on deciding anything. The places they’ve looked at, by the way, are near them in Florida. I live in Georgia with my family and would prefer them to come here so we could help them out (and they could see their granddaughter more). They are convinced that if they relocated here they’d be too much of a burden. I’m trying to convince them that it’s more of a burden having to travel eight hours and take days off work when things happen to them.

I realize and practice the trichotomy of control but I guess my question is how hard should I push? My brother and his wife are agreed it’s time for a ‘full court press,’ but I also don’t want to lecture or ‘make’ them do anything they (or he) doesn’t want to do within reason. I mean we could look into hiring nurses to come in, but that’s about as expensive as them moving to a more secure place and we’re never going to be able to hire 24-hour care. There wouldn’t have been a nurse there at 3am last weekend. The alternative is literally waiting for one of them to die and then taking off work at a moment’s notice to fly down and collect the survivor, since I don’t imagine either could survive for long on their own.”

This is a very common, and very hard, situation, particularly in the United States, where families are more likely to be scattered across the north American continent (as opposed to live in the same city, as is the norm in Europe), and where health care and care for the elderly are expensive and likely to become a significant financial burden. By comparison, both my grandmothers suffered from similar neuro-degenerative diseases by the end of their lives, and eventually entered a home for the elderly in Rome. In both cases the cost to us was minimal, and we could easily go see them as frequently as we liked. But you have to deal with your own local situation, and it sounds to me like you have put a lot of careful thought into it already, which is the hallmark of a good Stoic practitioner (and more broadly, of a decent person).

Let me begin with the di/trichotomy of control, which you bring up. My favorite interpretation these days is the one exemplified by the famous example of the archer given by Cicero in De Finibibus: hitting the target is “to be chosen but not to be desired” (III.22), because one realizes that preparing the shot is up to us, but actually hitting the target is not, as it also depends on externals over which we do not have control.

I interpret this to mean that we need to internalize our goals, being satisfied with making the best attempt within our powers to resolve a situation, but accepting whatever outcome — especially a negative one — with equanimity. This doesn’t mean, in your specific case, that you don’t care about your parents, but only that you realize that not only the situation is objectively difficult and that there is no ideal solution, but also that they are their own agents, wanting to make their decisions according to their own priorities, and that it is virtuous of you (specifically, an exercise in the cardinal virtue of justice) to treat them as you would like to be treated if the situation were reversed.

Your father may be stubborn, proud, scared, or simply genuinely not wanting to be a burden to you. But if he and your mom are of sound mind, then I would say that any “full court” intervention may risk violating their dignity as human beings. By all means, you and your brother should attempt to persuade them by way of reason and evidence — for instance actually drawing a comparison table of costs and burdens under the various options you are considering, to show them that their current assessment doesn’t fit the reality of the situation. But be careful not to treat them as children with reduced abilities to make decisions, not until there is actual evidence that either one of them is in fact no longer capable of functioning autonomously.

From what you describe it does seem like the logistic and financial burden on you would be reduced if they moved to Georgia, and perhaps you can still convince your father to do so. But that shouldn’t be your priority. You need to consider the situation, as Larry Becker puts it in A New Stoicism, “all things considered,” and those things include your father’s feelings and his need to feel that he is not imposing an undue burden on his son — even if he is, in fact, mistaken about which situation is the most burdensome.

Along similar lines, there is another imponderable and not necessarily rational element to consider, from your father’s perspective. I remember one of my grandmothers absolutely loathing the idea of going to live with one of her daughters — a sensible solution to the problems raised by her aging, before she developed a neuro-degenerative disease. She had been proudly independent all her life, and damn it she was going to lose that hard won independence at the age of 89!

It wasn’t a wise decision on her part, and it did complicate things later on. But I still feel respect for my grandmother because of that, and I can’t avoid thinking that I would probably react in a similar way under similar circumstances (I too put a high premium on independence). That sort of consideration too needs to be entered into your ledger. Sometimes, often perhaps, people don’t reason in the most practical way, but a strong sense of agency is one of the major components of human happiness, as again pointed out by Becker in this video on Stoicism and disability. You and your brother should certainly consider the extreme step of forcing your father into something he doesn’t like, if absolutely necessary. But it should be clear in your mind that such step would be extreme, and is to be taken only as the last resort.

I would add one more consideration, which is for you to use the current situation as a way to reflect on your own old age, which — Fate permitting — you will eventually reach. Seneca’s letter to Lucilius on that topic (n. 12) begins with an appreciation of the period before serious trouble becomes apparent, i.e., before the situation in which your father finds himself:

“Let us cherish and love old age; for it is full of pleasure if one knows how to use it. … Life is most delightful when it is on the downward slope, but has not yet reached the abrupt decline.” (4-5)

But then it shifts to a mood of appreciation of every additional day, which applies to every moment in our lives, including the period your dad is experiencing:

“Let us go to our sleep with joy and gladness; let us say: I have lived; the course which Fortune set for me is finished. And if God is pleased to add another day, we should welcome it with glad hearts. … When a man has said: ‘I have lived!’, every morning he arises he receives a bonus.” (9)

As someone who has lost both of his parents, and having gone through the loss of the second (my mother) with the support of Stoic wisdom (in contrast to when my father died, several years earlier), I can tell you that those are precious words to live by. Enjoy every moment you have with your parents, and try to make them appreciate that they should want to do the same, by moving nearer to you, regardless of the real or imaginary burden they think they may add to your responsibilities.


3 thoughts on “Stoic advice: my parents are elderly and losing their autonomy

  1. Your grandmother was alone,but the father in this casehas a special responsibility to his wife, given her condition. He will be more able to discharge that responsibility if they move to Georgia. If presented with this perspective, he may (the questioner thinks he should, but as you say, that is not and should not be decisive) regard this as outweighing his virtuous wish not to impose a burden.

    Trivia: losing not loosing in title. Type 2 diabetes responds well to very low carbohydrate diets, but I presume that the father has access to good medical advice.

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  2. Paul,

    Yes, he’s pretty good about his diet and care. In fact one of the reasons he’s reluctant to move is he is comfortable with his doctors. Of course my brother and his family live near a Mayo Clinic and I live near Emory hospitals and they’re not exactly a bunch of yahoos…


    Thanks so much. Since I sent you my question I wrote my dad one last letter trying to convince them that it’s time to move to a facility (either here or there in Florida). I didn’t push the idea of coming here (except to mention it’s cheaper!) You are correct about the idea of independence being a concern for him. But the places we’ve looked at are not full of rules and regulations. He can still drive (well, I don’t think he should be but whatever) so he could come and go as he pleased eating there or not as is his wish. They will give him as much or as little help as requested. My parents would really only be changing their address and having access to the help they needed when they needed it. I think my strongest argument was that he would be in a place full of people that hadn’t yet heard all of his stories!

    Anyway, I just mailed it and await a response. In the meantime I’ll continue to call and check on them, try not to pester them with my concerns, and really enjoy our chats and time together as you advise.

    Thanks again,

    Oh and yes, Paul is right. It’s “losing” not “loosing” in the title.

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