Six years ago, I moved to London with my wife. In my first job here, I got along really well with someone from my team. At that point, we were just work friends who would occasionally share a drink at the bar next to our office.
In 2022, my wife and I split up, and I found myself heartbroken and completely alone. Although my friend and I were no longer working together, I was desperate for company, so I reached out. We started hanging out regularly. He helped me heal from my breakup, and I couldn’t have done it without him. We became really close and shared good times.
But as I recovered from my heartbreak, I started to notice he had some views on gender, minorities and the current state of the world that I couldn’t disagree with more. Though his views aren’t extreme, they touch on topics that are very close to my heart. I’m starting to think that this might be something nonnegotiable to me, but the idea of cutting ties with someone who helped me more than anyone when I needed help the most makes me feel very ungrateful. Should I “break up” with him? — Name Withheld
From the Ethicist:
You’re treating your friend’s views on these topics as an unchangeable given. Maybe for good reason. It’s possible that you’ve contested some of his unpalatable opinions and he’s just dug in. Still, one thing friends can sometimes do is draw on a stock of trust and good will to have harder conversations than strangers can. So, if you haven’t, it may be worth talking through your disagreements.
But you’re not required to hang out with someone whose views make you feel you’re betraying your own commitments. If engaging him doesn’t work, and you still find yourself chilled? Being grateful for what someone did for you doesn’t entail a lifetime commitment to them. Friendship isn’t a debt instrument. On the contrary, it’s supposed to be of ongoing value to both parties. Aristotle thought that in the best friendships, each friend would admire the character of the other. I think his ideal is too demanding. Most friendships survive on something less exalted: affection, habit, shared history, a knowledge of someone’s virtues and flaws and a willingness to cut each other slack. We can enjoy someone’s company not despite but because of our disparate outlooks. There are limits, though. If what you’re encountering goes beyond disagreement and leaves you feeling compromised, you’re entitled to step back.
A Bonus Question
I’m an American who lives abroad with my family. On a recent vacation to the United States, my daughter spent five days in the intensive-care unit after a freakish event. We have insurance, but it maxed out on the first day. After she recovered and was discharged, my wife and I received a bill for $250,000. We are deeply grateful for the world-class care that most likely saved her life. We expected out-of-pocket costs, but we were caught off guard by the final number. (In fact, I declined to sign waivers saying I would be liable for anything insurance did not cover.)
We can pay a bill of this size, though it would put a big dent in our savings. We’ve now heard a wide range of advice, including from legal and hospital professionals: They say nobody pays the “sticker price.” One professional said that if we refused to pay, a hospital would not pursue the case, and their collections agency would have difficulty collecting.
Legal ramifications aside, we struggle with the ethics of paying nothing and having that on our conscience. But we also struggle with a health care system that collects at different rates. What is the right thing to do? — Name Withheld
From the Ethicist:
The ethical problems here aren’t on your end. A hospital’s “charge master,” its internal price list, is an instrument for bargaining with institutional payers. It’s typically a multiple of actual costs, sometimes a huge one. When an individual is billed $250,000 and an insurance company would be billed $60,000 for the same care, a hospital is imposing a pricing penalty on the most vulnerable payers.
You never agreed to this price, and given that you live abroad, it may be correct that the hospital would have trouble collecting on the bill. You did expect to pay something, though, and you should. Courts often limit hospitals to recovering the “reasonable value” of their services, based on Medicare or the rates that commercial insurers negotiate. So start by requesting a fully itemized bill and, ideally with the help of one of your expert advisers, review it carefully; errors are common. Then tell the hospital billers that you propose to pay something like reasonable value; even if that’s double the Medicare rate, it will come in far below the charge-master number. The alternative to negotiating is to help prop up a wrongful pricing regime.
Readers Respond
The previous question was from a reader who wondered whether she should sacrifice her retirement plans to help a cousin in poor financial straits. She wrote:
“I’m a woman in my early 50s and financially secure. … I am close with a cousin who is a decade older than me and can’t manage his money. He gambled away a six-figure inheritance, despite my (repeated) pleas years earlier to his parents and to him to protect his money from his own bad judgment by creating a trust. … He has exhausted his unemployment, hasn’t paid his rent and is ignoring the information I send on programs that could help him afford rent and health insurance (which he doesn’t have). … I am out of ways to help him help himself. Could I pay his rent for the next year? Yes. Would it impact how I would like to live in my retirement? Yes. … I’ve eaten PB&Js for 35 years in an effort to have a retirement where I can do what I want. Is it ethical for me to do that while my relative, whom I love but can’t fix, is facing a homeless shelter? — Name Withheld”
In his response, the Ethicist noted:
“There’s an old story about a man in a flooded town who, perched on his rooftop, successively waves away two rescue boats and a helicopter, insisting God will save him. He drowns, meets God and asks why he wasn’t saved. God’s reply: “I sent you two boats and a helicopter.” You can take this to be a fable about providence, but in secular terms, it’s also about the limits of rescue. What impresses me is how much you’ve done for this man. … But, as the coaches say, you can’t want it for him more than he wants it for himself. … Let me suggest, further, that an ethical view should be attentive to your own welfare, not just everyone else’s. … Working longer, shrinking your own future — these are harms that, ethically speaking, you should take into account. You can’t be obligated, as an individual, to subsidize someone’s life indefinitely when he won’t do what’s needed to make that subsidy unnecessary. You sent him two boats and a helicopter. It was up to your cousin to step onboard.”
(Reread the full question and answer here.)
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The letter writer must be a kindhearted woman. She has already done so much for her cousin over many years. She must accept that she will not save this man from himself and start making her own life her top priority. This story has played out multiple times in my family — beloved relatives who simply couldn’t find their own two feet to stand on. It can hurt to exercise tough love, but ultimately the efforts to save them will be unsuccessful. So be kind and tell him no. — LeeAnne
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Two things matter here. First, generosity must be met with genuine effort; otherwise it becomes enabling, not support. Second, it is never fair for love to be leveraged into ongoing exploitation. Care requires some measure of reciprocity and balance within a given context, even when the scales aren’t equal. In this case, it sounds as if you’re carrying both sides of the burden. — Shawnna
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I advise the writer to look into support groups for friends and family of addicts. Gambling is an addiction, and even if the family member is no longer gambling, judging by his behavior he is continuing to struggle in ways only he can confront. Trying to control and fix the addict’s behavior will just make the writer miserable. Frankly, well-meaning efforts by family can do more harm than good. The best thing you can do is put yourself first — it is not only ethical, but healthier for everyone involved. — Kate
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Chronic self-sabotage, rejection of viable help and repeated crises can signal untreated mental illness, not mere irresponsibility. Ethically, that distinction matters. Before concluding that further help will only delay a reckoning, there is a moral case for conditioning assistance on a comprehensive mental-health evaluation and treatment. The goal would not be indefinite subsidy, but restoring the cousin’s ability to act in his own interest. Only after that question is answered can we fairly say that he has refused the boats that were sent. — Christopher
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I believe that sometimes things need to get worse before they can get better. Continuing to provide a “safety net” of loving aid may have given this cousin an assurance that he won’t really have to face the reality of his situation. I agree with the Ethicist. Enjoy your retirement. — Jeanne
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