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 Withheld
A 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.”
