My elderly in-laws are living in a home that is unsafe. The outside of the home is extremely unkempt, and the inside is horrible; the hoarding has gone on for many years. They refuse to get help to clean it out or even discuss it, and I fear for their safety. If a fire started, they would never get out alive. My daughter’s spouse and his family have given up trying to persuade them to accept help. Is it unethical for me to call authorities (secretly) for a well-being check? It might force my son-in-law’s parents to deal with their mess or it could cause them to lose their home. I feel awful that they live this way. — Name Withheld
From the Ethicist:
Talk of hoarding conjures images of dragonlike greed, but that’s not the reality. Your in-laws are likely experiencing what researchers call “executive dysfunction”: Their brains have lost some capacity for the relentless decision-making that modern life demands. Each day brings a barrage of choices — what to keep, what to discard, what to buy, what to ignore. For aging minds, this can become overwhelming.
Yet while hoarding disorder is a recognized psychiatric condition with real dangers, the squalor you perceive is, in a sense, your problem, not theirs. They don’t see their living situation as problematic. That’s one reason a wellness (or welfare) check, typically performed by law enforcement, is unlikely to achieve what you’re hoping for. Officers usually lack psychiatric training and cannot force someone into treatment unless strict criteria for involuntary commitment are met. At best, they might clear a path to the door; the underlying condition would remain untouched. And your in-laws could well see such a visit as a betrayal, potentially straining family relationships.
There may be less disruptive ways to intervene. You might, for instance, explore whether Adult Protective Services could be helpful. Or contact their doctor. Although privacy laws would likely prevent the doctor from discussing a patient’s case with you, you can still voice your concerns, and the doctor might raise safety or health issues at their next visit. Because hoarding is sometimes tied to depression or anxiety, a broader mental-health evaluation could also be helpful. Still, even the best therapeutic interventions have a modest track record. Research suggests that cognitive-behavioral therapy, the supposed gold standard, falls short for older adults. Dramatic measures, such as complete home clean-outs, almost always fail; the behavior simply resumes.
Your in-laws have created a world that makes sense to them. The ethical question isn’t just about safety; it’s about their right to live according to their own diminished logic. The most realistic approach may be to abandon the fantasy of fixing the situation and turn to what the experts call “harm reduction.” Offer assistance with organizing, not discarding. Frame your involvement as support, not intrusion. Help clear a single pathway rather than an entire room. Make sure smoke detectors are installed and working. Maybe visit a little more often. This is one of those problems that probably has no real solution. All you can do is keep caring, keep communicating and keep looking for opportunities, however small, to enable your in-laws to live safer, healthier lives.
Readers Respond
The previous question was from a reader with a diagnosis of breast cancer who wanted to let her family members know that they were eligible to be tested for a genetic mutation. She wrote: “I’m being treated for cancer and was referred to a genetics counselor. He informed me that because two other people on my side of the family have also had cancer, I’m eligible for screening for BRCA mutations, which increase the risk of breast and ovarian cancers.
“I believe I should inform my family about our eligibility for genetic screening without specifically mentioning BRCA to avoid panic. … Does this approach seem reasonable, or am I obligated to share specific details with all potentially affected family members?”
In his response, the Ethicist noted, “It’s completely understandable to hesitate about genetic testing that won’t change your medical care, especially given the weight such information carries.” But he went on to say: “There’s a reason that such screening is made available. There’s also a reason that it’s a decision. By informing your relations that your family history qualifies everyone for genetic screening, and suggesting that they speak with their doctors if they wish, you’re encouraging them to make their own informed decisions. You’re not hiding information; you’re offering support and leaving the door open for more conversation if they want it. In short, you’ve thoughtfully balanced your own care with consideration for others. May that approach guide you in all that lies ahead.” (Reread the full question and answer here.)
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As someone who has a family history of hereditary cancer, I have had to make this type of decision and, through an organization called FORCE (Facing Our Risk of Cancer Empowered), spoken with others in a similar situation. One question I asked myself was: If I did not share the information, and someone developed a cancer that might have been prevented if spoke up, how would I feel? That helped give me the resolve to share the information, even though it felt uncomfortable. Knowledge is power, and sharing the knowledge would empower the writer’s family members. Even if they did not want the genetic testing, the family history might also qualify them for more intensive cancer screening, so there are various ways the information could be helpful and potentially lifesaving. — Kate
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As a 20-plus-year survivor of breast cancer, I can tell the reader that as she progresses through treatment and recovery, she will most likely have a changing relationship to her diagnosis. In particular, her identity may move from “cancer victim” to “cancer survivor,” and this may change how she feels about her treatment choices and genetic testing. Considering she very likely has many more time-sensitive decisions to make, this one can wait. — Amy
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My sister was found to have metastatic breast cancer at age 52. She said yes to testing and to sharing that information with her siblings — which includes our children and cousins — and we now are able to plan for the future and take precautions to reduce our risk. I recommend this person tell all her relatives that the concern is for BRCA. My sister has since died. Before my sister died, she asked me, “Did I do any good?” I told her she saved us all. — Name Withheld
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Letting relatives know that genetic testing has been suggested is the absolute minimum that this person owes her family — but especially her twin. As a third-generation cancer survivor, I wish that I had been given this information long before I developed cancer myself. I could have had a 15-20 year head start on making decisions about my health. I shared the letter my genetic counselor provided with my family as soon as it was available to me. — Robin
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Some health organizations will do a BRCA screening if multiple relatives had breast cancer; in my family’s case, there were three. We don’t have the gene, but we do have a prevalence of hormone-sensitive cancers that is worth paying attention to. No reason that I can see for being “delicate” about talking about it to your family. — Anne
Kwame Anthony Appiah is The New York Times Magazine’s Ethicist columnist and teaches philosophy at N.Y.U. To submit a query, send an email to [email protected].
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