The burden of caring for people who make it incredibly difficult

Am I Obligated to Look After My Insufferable Mother?

The magazine’s Ethicist columnist on not helping family members who make it difficult to help.

Credit…Illustration by Tomi Um

By Kwame Anthony Appiah

Oct. 4, 2022

My mother has an undiagnosed mental illness that makes her incapable of accepting reality and that has caused her to be emotionally abusive my entire life. My sister and I have maintained a relationship with her, but with strict boundaries and limited visits.

She lives alone in a home she inherited, which is falling apart. She is a hoarder and won’t let in repair people or anyone else for that matter.

She is 69 years old, hasn’t seen a doctor or dentist in decades. Her car stopped running long ago, and she walks a mile or two to the supermarket, even in winter. She lives off a meager Social Security income. Her pets are not properly cared for, yet she won’t let me adopt them.

What options do my sister and I have as she ages and her living situation deteriorates further? And what obligations do we have toward her? She will never admit anything is wrong with her, and neither of us is willing to let her live with us. She would ruin our lives and our families’ lives. This situation is like a dark cloud looming over our heads. My sister and I are the only ones in her life who can help her, but neither of us can afford to support her financially or otherwise. Name Withheld

Your mother is making bad choices, but you can’t require her to make good ones. Nor are you obligated to blight your own life in order to make hers less awful. She certainly isn’t asking this of you. As long as she doesn’t meet the very demanding conditions for involuntary commitment — which vary from state to state, but typically involve a “danger to self or others” standard — you can’t do very much about her situation. With one notable exception: If the way she treats her pets amounts to cruelty or neglect, you might decide to involve the local authorities responsible for animal welfare. She won’t appreciate your interference, but you’ve already tried to get her to do the right thing, and the animals deserve proper treatment.

The story changes if she eventually becomes incompetent — or, depending on her jurisdiction, is determined to “lack the capacity” — to look after herself. You and your sister can then apply, as her children, to have her hospitalized for treatment. Given your limited resources, you will have to leave it to the state to take care of her. Discuss the options with the appropriate social-welfare authorities, so that you are ready to act when and if that time comes.

It’s extremely distressing to have a family member who is mentally ill in ways that make it difficult both to care for her and to maintain a normal relationship. In nonextreme circumstances, though, it’s probably better that the law sometimes errs on the side of respecting people’s autonomy. This means that we can’t do the things that would enhance their well-being, like forcing them to get medical and dental examinations. But the value of autonomy — the freedom to live our lives our way, regardless of whether it’s the “best” way — rightly demands considerable deference. Well-being isn’t all that matters.

I have a middle-aged sister who has struggled with a personality disorder since adolescence. It has been challenging for her to hold a job. She has relied on my parents for assistance to raise her son, who is now grown, and to cover all of her living expenses, even as they have moved into their retirement years and live on a fixed income.

I told my parents that I do not intend to support her when they are no longer able to or are no longer living, because she refuses to take any responsibility for herself or to comply with medical or mental health care plans.

Now my parents are suggesting that I help with some of their expenses. But they would not need assistance if they were not dedicating a significant portion of their income to my sister’s support. How do I determine what my obligations here are? I have adolescent children to whom I also have obligations, like paying for college. Name Withheld

You clearly think that your parents have been enabling your sister’s dysfunction. She would have been better off, you believe, if she had to take on more responsibility for herself. And it’s true that we can disrespect people by treating them as if they were incapable of doing what they really could do. That’s an especially strong temptation for parents of ill children, who often struggle with feelings of guilt.

Still, you’re taking a position about what the facts are. And wishful thinking — believing what we’d like to be true — is a perennial human weakness. So suppose, for a moment, that your sister were truly incapable of looking after herself. Perhaps you’ve resisted the truth because accepting it would entail a serious imposition on you. Perhaps your perspective has even been distorted by resentment at watching your parents give your sister greater support and attention than they’ve given you.

I have no strong reason to believe that this scenario is true. I’m asking you to entertain it simply because you’ll need to have a clear picture of the situation before proceeding, and it’s responsible, in such cases, to consider the possibility that you’re mistaken. Talking through your concerns with everyone involved might be part of making sure you aren’t. You have a better chance of using your combined resources — financial and otherwise — to best effect if you can come together on a plan of action.

If you’re confident in your appraisal of the situation, you should push your parents (and your sister) to see that, whatever has happened in the past, it is not too late to ask your sister to assume more responsibility. You can also remind your parents that you have commitments to your own children and your own life, and that you don’t want to help sustain practices you judge to be mistaken. Your sister, in turn, should confront the fact that your parents have limited resources that must last their lifetimes and that they can no longer afford to prop her up as they once did. Given that she’s accustomed to expansive parental largess, of course, a period of adjustment should be allowed for. And there are organizations, like the National Alliance on Mental Illness, that aid people with mental illnesses in finding support groups and other resources; you can help her look into them.

My sister, who is in her 70s, lives across the country. We have been estranged for many years. That was her choice, but it’s OK with me, because she has an extremely difficult personality and is filled with irrational resentments. I heard that she is in a bad way — broke and perhaps experiencing dementia. I am her only family, and I’m grappling with how much I should do for her. She lives in a remote area and needs pretty much everything: an evaluation of her mental and physical health; a new place to live; someone to clear out her house and sell it; and, perhaps, protection from those who might try to exploit her. Should this fall to me? Name Withheld

In a society where public provisions for the indigent and mentally ill are more limited than they should be, friends and family are, inevitably, important sources of assistance. Given that you and your sister no longer have a relationship, though, it’s not obvious that an offer of assistance from you would be well received.

All the same, it would be worth figuring out what forms of aid — federal, state, local, philanthropic — are available where she lives. I’m guessing that your sister is among the many people who are not equipped to make these inquiries. It would be an act of kindness, if not a sisterly duty, to do so — bearing in mind that it’ll take more than a phone call to get your sister the help she needs.

In all the cases I’ve discussed in this column, my ethical bottom line is that we owe more to family than we do to strangers, but less to alienated family members than to those with whom we have positive ongoing relationships. So decide what financial and emotional resources you are able and willing to devote to helping her out. You can set reasonable limits here; again, you don’t have to derail your life in the attempt. Still, you’re obviously concerned about her. She may not be glad that you’ve made efforts on her behalf, but I suspect that you will be.

Kwame Anthony Appiah teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to; or send mail to The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018. (Include a daytime phone number.)

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