Editor’s Note: Every Wednesday, James Hamblin takes questions from readers about health-related curiosities, concerns, and obsessions. Have one? Email him at email@example.com.
Dear Dr. Hamblin,
My grandmother recently lost her husband and son, and was in a car accident that broke her hip and back. Because she has significant hearing and vision loss, she was told she would never be able to drive again. She is in her late 80s, is underweight, and lives with many chronic health issues, including heart disease, kidney disease, colitis, and anemia. She’s also understandably depressed in light of her personal situation and the pandemic, which has made her more lonely living in an already-isolated rural area.
So I moved to Virginia to serve as her caretaker. I’ve done my best to keep her as safe as possible. We go to the park, have socially distanced visits with friends in their backyards, and pick up to-go orders from her favorite restaurants and wineries. The only thing I’ve refused to do for her is take her to the hair stylist. I understand that getting her hair done is important for her emotional and social well-being, something she’s done every week for as long as I can remember. But I just couldn’t in good conscience put her in a situation that I believed was dangerous.
For a while, she was satisfied with my weekly hair washing and curling, but when our state reopened hair salons, that changed. Yesterday, she called me “mean” for refusing to take her. As a first-time caretaker, I’m really struggling with this. How should I strike a balance between her quality of life and her safety?
This is a beyond-difficult time for caregivers. The job was intense and mostly thankless even before the pandemic, but now, caring for a frail octogenarian means you have to think about everything you do as something that puts the person at risk. You and others in similar positions deserve more credit than I can begin to express here.
No matter how much you love your grandmother, or anyone, isolating together can bring tension to a boil in ways that wouldn’t happen in normal times. So I hope it’s helpful to hear this: Let your grandmother get her hair done. Make sure she and her stylist and anyone else involved take proper precautions. Make sure she understands that even with precautions in place, there are still risks involved—not only of her getting the virus, but of you getting it, too. If she still insists, take her to the salon, and know that you’re doing the right thing, because it’s what she wanted.
I know that goes against your basic instincts as a caregiver. You didn’t move to Virginia so you could drive your grandmother to the salon for her to get a disease from which she’d have a high likelihood of dying. But we should be clear that what you’re describing is—from a purely medical perspective—a woman approaching the final years of her life. This is always uncomfortable to acknowledge, but it’s important to do because it informs how to make these types of decisions.
A common tendency in these situations is wanting to swoop in and do everything in our power to keep a person physically healthy and, well, alive for as long as possible. But in the process we run the risk of denying agency to elders. Just because people aren’t able to drive, cook, or care for themselves in certain ways doesn’t mean they should lose autonomy in other ways, such as making decisions for themselves. It’s actually crucial that they don’t.
Caring for aging parents and grandparents is sometimes blithely compared to caring for children. In both cases, we always think we have their best interest at heart. But old age is not childhood; it’s a totally distinct phase of life. With children, we aim to keep them safe at all costs. We act as though we know what’s best for them, because we do—or at least we can confidently pretend to.
In caring for elders, their dignity and autonomy are paramount. The goal is to maximize quality time, striking a balance between prolonging life and making it comfortable and joyful. Striking the proper balance isn’t defined by some external standard; it’s defined by their own wishes. We non-elders are rarely positioned to deem those wishes valid or invalid. Even as bodies break down and memories start to fade, as long as people have the cognitive capacity to make decisions for themselves, our job as caregivers is to enable fulfillment of those wishes.
But the crucial caveat is that this situation would change if your grandmother were refusing to wear a mask or attempting to do things that put other people in harm’s way. She shouldn’t be throwing dance parties. This sort of situation is where it could become morally defensible to step in—for an elder or for anyone else who’s doing things that put people at risk. Autonomy ends with recklessly endangering others.
In terms of things like hair salons, this is where public-health policy can take a lot of burden off individuals. If establishments are to open, officials should require everyone involved to wear a mask. Building codes should ensure good ventilation.
Still, for the foreseeable future, things like haircuts will never be perfectly safe. Getting a haircut isn’t even a zero-risk proposition in normal times, with someone looming over you with various sharp instruments. The pandemic should force us to pare down to only the things that are most beneficial and least risky to us. It’s going to last a long time, and we can’t give up absolutely everything.
Overall it sounds like your grandma is being very careful. She is frail and sick and grieving, and wants to do one semi-risky thing that has a lot of value to her. If she’s doing it as safely as possible, you can disagree with her decision, but I wouldn’t refuse her autonomy. The experience of going to a salon has value beyond looking good—and even more so in this moment, when community and ritual are hard to come by. Wanting that glimpse of normalcy is not trivial or superficial or vain. For your grandma, this one may be worth it.
But truly, it’s not up to me, and it’s not up to you.
“Paging Dr. Hamblin” is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. By submitting a letter, you are agreeing to let The Atlantic use it—in part or in full—and we may edit it for length and/or clarity.
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