In this latest edition of The Ethicist, a long-time caregiver grapples with a heart-wrenching dilemma: Can she place her husband, who has Alzheimer’s, in a memory-care facility and move to Europe to be closer to her children? The moral weight of her decision is heavy—on the one hand, professional care might better serve his needs, but on the other, the deep loyalty built over decades of marriage tugs at her conscience. Philosopher Kwame Anthony Appiah argues that this isn’t merely a question of rights, but of honoring the life they shared: “What has weight here aren’t his ‘rights’ but the deep loyalties that arise from a shared life.” While the wife never got to discuss this with her husband before his cognitive decline, she must now rely on what she believes he would have wanted for her, balancing duty with self-compassion. The takeaway? These are the conversations couples should have before illness makes them urgent.

Key Points:

• The letter writer’s husband has Alzheimer’s; she is his full-time caregiver but wants to move to Europe to be near family.
• She feels guilt over leaving him in a memory-care facility and questions whether it is morally acceptable.
• Appiah argues that proper care might be beneficial for her husband, but her ongoing presence in his life could still matter, depending on his cognitive state.
• The dilemma isn’t just about personal rights; it’s about the moral responsibilities embedded in a long-shared life.
• Since she and her husband did not discuss this scenario while he was well, she must now act based on what she believes he would have wanted.
• The broader lesson: Couples should discuss long-term care decisions before cognitive decline makes those discussions impossible.

Would you make the same choice in her shoes? Let us know your thoughts!
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