Shouldn't my dad be told that he has Alzheimer's?

He's a shell of himself, but my mom hasn't told him why.

By Cary Tennis

Published February 12, 2008 12:03PM (EST)

Dear Cary,

I'm a soldier, and have been for over 20 years. I've been overseas more times than is comfortable (and have the divorce to prove it) and am a fairly confident fellow. However (and you knew this was coming), I've discovered something that has shaken my confidence, and my perception of myself and my family. My mother confided to me that my father is suffering from Alzheimer's, and his lucidity will likely fall away fairly quickly. Fortunately, I was able to spend Christmas 2007 with them and have some comforting memories of the short amount of time I was able to spend with them.

During my childhood, my father towered over me -- maybe not in physical stature, but surely in every other way. He was the personification of what a man and father should be. Strong yet gentle, firm yet understanding. He loves my mother with a passion and depth that I only appreciate now. Although he was away for much of my childhood, he provided me an example of what a man should truly be. When I went home for Christmas, I found my father to be a shell of what he once was: unable to walk on his own, with a failing memory and no small amount of vitriol for those around him, including anger at what he didn't understand and couldn't control. I am aware that this is part of his condition. I don't envy the frustration he feels -- the loss of mobility, the failing ability to perceive reality.

I suppose the real difficulty for me is that he is unaware of his condition. My mother hasn't told him the diagnosis. I understand her actions, but I can't help imagining myself in the same situation, knowing reality was slipping away but uncertain as to the cause.

My issue is a selfish one. I want to be honest with my father, but I am also aware that I'm far away, and am unlikely to see him again in a state in which he would even recognize me. This isn't an issue of unstated emotions or feelings, but one of honesty. Should I tell him what he faces, or remain silent and let him slip into a comfortable numbness, unaware of what is happening to him?

Soldier John

Dear Soldier John,

I think your father has a right to know about his diagnosis, but he should be told by his doctor.

If that were all there is to it, this could be a one-sentence column.

But there is always more to say. For instance, how do you ensure that he is told, if your mother does not want him to know? And are you sure that he does not know? He may have been told but not give signs of knowing.

Because, well, consider this: The deterioration of his brain changes the meaning of "to know." Even if he is told of his diagnosis, he may not completely understand what is happening to him the way we understand, say, that we have a broken leg that has to heal or that we have permanently impaired sight. His understanding of his condition may not be what we think of as "knowledge" -- the stable and orderly persistence of an image in the mind, available to recall and modification by new information. Yet he may in some way "know."

Regardless of what he "knows" or does not "know," I think we have a moral obligation to treat him as a person capable of understanding, and thus to tell him of his condition, to treat him as though he can understand even if he fails to give us the accustomed signals of comprehension.

At the same time, don't kid yourself: Where his decisions have impact on his care, or on the well-being of others, you and/or your mother have to step in.

This is where it gets tricky for sons and daughters. We sometimes see our parents as strong and competent even as they fail before our eyes. So keep in touch with your mother about his affairs, and be sure that in matters of importance she has adequate professional counsel.

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