I grew up in an evangelical Christian home-schooling community, though I left it at 14. My sisters remained in that world and attended evangelical colleges, where marriage and child rearing were strongly emphasized. Six years ago, one of my sisters and her husband became foster parents to a newborn who was removed from his biological mother’s care because of her severe drug addiction and medical incapacity. Fostering and adoption are common in our community, and my sister and brother-in-law hope to eventually adopt this child.
The child has serious behavioral problems. Since about age 3, he has regularly punched, kicked and bitten my sister, his primary caregiver, who is five feet tall and about 90 pounds. I have seen bruises and bite marks on her body and watched him strike her repeatedly in the face and head with closed fists, sometimes for two minutes or more. I have also seen him attack another young child he had never met.
As he has grown older and stronger, the violence has escalated. He was receiving individual behavioral support from an aide who accompanied him at school. Two weeks ago, however, my sister dismissed the aide after the aide intervened while the child was attacking her. Over the years, she has dismissed other professionals who recommended behavioral interventions or expressed concern.
Neither my sister nor her husband sets meaningful limits. When the child hits her, my brother-in-law sometimes laughs or offers him a sweet to distract him. Neither parent tells him that violence is unacceptable. They avoid saying “no,” fearing it will intensify his outbursts.
I worry that the child is not receiving the care he needs and that my sister is in increasing danger as he gets bigger. I also worry that, because she and her husband hope to adopt him, they may be reluctant to disclose the full extent of his behavior to state agencies and care providers.
My main ethical dilemma is whether to report what I have witnessed to the state’s child-welfare agency. I suspect my sister would know I was responsible and might permanently cut off contact with me. I would then lose any ability to know whether the situation was improving or deteriorating. My other sisters believe I should remain silent for that reason.
Do I have an obligation to report what I have witnessed, even if doing so is likely to destroy our relationship and further isolate my sister? Or does preserving access to the family give me a better chance of helping?
I also face a more immediate dilemma. What am I obligated to do when I witness an attack? When I have told the child that he is never allowed to hit my sister, he has redirected his aggression toward me, and my sister has blamed me for escalating the situation. I can intervene to protect her or stand by in deference to her wishes. — Name Withheld
From the Ethicist:
Given what you’ve witnessed, you owe it to both your sister and the child to make sure that the foster agency understands what’s going on. The choice isn’t just between respecting your sister’s wishes, on the one hand, and protecting your sister, on the other. You also need to consider what’s best for a child who isn’t receiving the developmental support he needs. The American Academy of Child and Adolescent Psychiatry specifically cautions adults against minimizing violent behavior in children and, when the violence is concerning, recommends comprehensive professional evaluation.
Foster care aims to place a child with a family capable of providing the needed care. This plainly hasn’t happened here. You point out that if your sister cuts you off, you “lose any ability to know whether the situation is improving or deteriorating.” But what does that knowledge gain you if you can’t act on it and must remain silent about a worsening situation? Your sister and brother-in-law are caring for a child for whom the state still has substantial responsibility, and the foster agency can’t do its job if it is denied critical information about the placement.
As for your second question, I don’t think you’re required to sit back and watch someone hit your sister in the head. Protecting your sister and protecting the child are, in the end, aligned interests. This child is in a bad situation, and as he gets larger and stronger, the likely consequences for him will become much harsher. Effective intervention now protects him too.
Readers Respond
The previous question was from a reader who was unsure of how much to reveal to an elderly relative. She wrote:
My mother just died at age 69. She had been divorced from my father for more than 20 years, lived alone and had been estranged from me, my sister and her own mother, her only remaining family, for about a decade. She also had serious, undiagnosed mental health issues. My grandmother is 94 and has dementia. Her short-term memory is very limited, though some recent events, like the death of a cousin, have stayed with her and still upset her. I’m torn about whether to tell her that her daughter has died. The news could cause her real anguish and possibly affect her physical health. I also worry that she might forget and then have to learn, and grieve, the loss repeatedly. At the same time, despite their estrangement, it feels as if she has a right to know. … Is there a best course of action here? — Name Withheld
In his response, the Ethicist noted:
I’d talk to the clinicians and caregivers who deal with your grandmother every day, and try to assess whether you could give her the news without that looping effect that you fear. If they think you could, there’s a good case for telling her, once. It’s possible that your grandmother retains what the philosopher Agnieszka Jaworska calls the capacity to value, which, she argues, can persist even when dementia has eroded the ability to reason and come to rational decisions. The point is that a daughter’s life and death may still have significance for your grandmother. … But if your grandmother is unable to hold onto the news, it would be unkind to keep telling her. She may still be capable of grief in the moment, but repeated disclosure could subject her to the shock of bereavement again and again without her being able to move through it. Your mother and grandmother haven’t seen each other in a long time, and your grandmother isn’t expecting to see her daughter again. In those circumstances, it may be more respectful of her to protect her from a loss she can no longer meaningfully absorb than to repeatedly confront her with a truth she cannot retain.
(Reread the full question and answer here.)
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My mother has dementia and unless the news makes her day better, I don’t tell her. It took me a long time to feel comfortable “lying” to her. But sparing her the pain of reliving my father’s death over and over is more important. Especially since your mother and grandmother were already estranged. — Holly
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My mother-in-law had dementia when her oldest son died. We decided, with the help of the social worker at her assisted living facility, to tell her once (and just once) so as to give her the opportunity to grieve. It felt like the right and compassionate thing to do. She deserved to know, even if she soon forgot. And we never mentioned it again. — Marian
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I provided care to a woman with advanced Alzheimer’s years ago. She had lived with her parents her whole life, but they were gone when her Alzheimer’s diagnosis arrived. She was lovely with me, but the entries in the care journal indicated others were not so fortunate; she would get angry, throw things, yell, etc. Then, I realized that one thing I was doing differently: One of her biggest fears was repeatedly and frequently expressed as: “Where are my parents? They would not want you here.” Other caregivers tried to explain her parents were gone. These sessions almost always triggered later outbursts. Me? I figured she was not going to retain the information, so why hurt her with it? My story was the same every time: “Your parents went on a trip, remember? They said it was OK if I stayed here with you until they got back, to keep you company.” And then we went back to looking at old photos or doing other things she loved. I have no reservations about that white lie. It allowed her beautiful, peaceful moments during what was surely a scary and confusing time. — Mary
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Having been close to my mother and mother-in-law, both 98, and both with moderate dementia, our families decided to tell then cheerful news or discuss sweet or funny memories with them. They lived from day to day with no recollection of the day before. Hearing of a death or illness of a family member is distressing, and could keep them distressed for days even though they may not understand why. Keep them in happiness. — Barbara
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I am a rabbi who had a similar situation. We decided not to tell the elder that her son-in-law, Howard, had died. Believe me or not, the next day, when the woman woke up from a light sleep, she announced to her caregiver, “They didn’t tell me that Howard died.” I guess Howard told her! — Andrea
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