Life is full of moral dilemmas and emotional puzzles—some big, some small. Take, for example, 24 year-old Mark Foster, who was faced with a decision that certainly falls into the ‘big’ category: Should he risk his life—or, at the minimum, compromise his own health—by donating part of his liver to his father?Before you knee-jerk to what might seem like the politically correct answer of ‘Why, yes, of course!’, read on. Mark’s father’s liver was damaged beyond repair because he refused to stop his excessive drinking after contracting hepatitis C. As an aside, he rarely communicated with his son other than to criticize him.
There’s more: Over a third of liver transplants end up with life-threatening complications, and a statistically significant number of donors die as a result of the operation. Those who don’t die suffer long-term health problems. As another aside, Mark’s mother was patently opposed to the procedure. She knew she was going to lose her husband eventually, and she did not want to risk losing her son too.
What to do?
Mark’s father had obviously made choices for himself, with little concern for the outcome. After the diagnosis, he continued to drink in defiance of compelling medical advice. He attended AA but found it too ‘depressing’ and opted to keep drinking. Is it a foregone conclusion, therefore, that Mark must now risk his life (and, without a doubt, compromise his own long-term physical well being) on account of his father’s self-destructive lifestyle?
People make harmful choices all the time. Some continue to smoke in spite of the obvious health risks. Some overeat until they are morbidly obese, in spite of the overwhelming evidence that it is a virtual death sentence. I wrote last year about a driver I watched speed through a red light at a busy intersection—without even the slightest glance right or left. All these people made conscious decisions to play the odds. Sometimes you win; sometimes you lose. The question is this: If (when) you lose, whom do you have the right to take with you?
In my view, Mark was under no moral obligation to help his father. I don’t criticize him for doing so, because he obviously loved his father in spite of his flaws. Yet if Mark came to my office and asked me what I thought he should do, I would advise him not to make the decision out of guilt, but to make the decision out of unqualified love.
If medical technology were at the ‘Star Trek’ stage, the decision would be a lot less difficult. Surgery would be quick and minimally life threatening. Although today’s medical procedures are yesterday’s miracles, transplants have not yet come that far. So Mark, as his mother pointed out, was arguably taking an unwarranted risk. His father had lived a longer life than Mark, and, most importantly, his health problems had been preventable. I would ask Mark this question: Would life without his father be intolerable enough that he must risk his own? For most people, life without a beloved spouse or child would definitely be worse, so the risk could well be worth it. Yet with a father (who’s lack of concern for his own health created the whole crisis to begin with), the decision might be a little more difficult. I would have urged Mark to look at it from this perspective.
Ultimately, Mark chose to provide the transplant for his father. The surgery went well, and after a long and painful recovery for Mark, both father and son survived. But the larger issue remains: How responsible are we for the self-defeating choices of loved ones? Especially in more mundane situations that are not quite so life-or-death.
A prime example is the dilemma that parents face when their grown children won’t leave the house to get on with their lives. I know of ‘children’ in their twenties and beyond who stay at home, often not working, and sometimes maintaining a drug or alcohol problem. Of course, their parents love them and feel responsible for them, yet at the same time they resent the intrusion and the mooching. I am not referring to temporary arrangements beyond the child’s control—I am referring to open-ended, highly questionable stays where the ‘child’ makes no effort whatsoever to move on. Naturally, the parents ask, ‘If I love my son [or daughter], how can I put him [or her] out on the street?’ My take on this is generally, ‘Is this what you signed up for when you had a child? To continue taking care of him well into adulthood, although he is clearly capable of taking care of himself? Did you create this situation for your child, or did your child do it?’ It is a rare human being who will not (at least for a while) welcome the ‘path of least resistance.’
Like Mark, such parents face the classic dilemma about love and responsibility: Does love include ‘being there’ unconditionally—even to your own detriment—when the loved one’s predicament is of his own making? Part of my goal as a therapist is to help people shed unearned guilt. I never want to tell someone what to do, but I do urge him or her to get rid of unwarranted guilt before making a major life decision. Putting your own life first, when someone else has failed to do the same for him- or herself, is no sin—no matter who the person is. Mark made his choice, and it was his to make. Fortunately, everything worked out. But if, on the advice of his mother, he had taken a different path, he would have received no criticism from me.