Once again, the holidays beckon families to gather, engage—or avoid—conversations about current events, and in the midst of the catching up and nostalgic stories, make countless quick assessments of each member’s health. Perhaps Grandma’s memory is failing, or Aunt Sue confesses that she’s struggling financially after her divorce, or your mother mentions retirement next summer, or your father passes on gravy because he is watching his cholesterol. In response to the assessments, each family member may be thinking, “If one of these loved ones needs my help, such as caretaking or a gift of money, what am I able to give? And, out of that ability, what am I willing to give?”
Whether explicitly religious or not, the values espoused in the Honor Commandment may be motivating the asking of these questions and the sense that one should answer them generously. The Honor Commandment “Honor your father and mother that your days may be long…” (Exodus 20:12) has long been a private and public value that honors the needs and dignity of our elders.
In 2010-11, we interviewed grown children who had provided care for a now-deceased parent or stepparent. Our research focused on sons, daughters, and stepchildren in Louisiana who explained how the moral impetus of the Honor Commandment served to inspire—and even require—the care given, the money spent, and the respect shown. Our overview of their modern day filial piety was published in the Journal of Law and Religion in June 2015. That article served as the launching point for our editing a new symposium volume of the Journal of Law and Religion that brought together a diverse cohort of scholars to begin a multifaceted conversation concerning the expectations, demands, and even ideals, of filial piety. These essays emphasize that caring for the elderly is an internationally shared value and responsibility and that every community finds creative ways to express and motivate honor, especially as the definition of family shifts in modern times to include many stepfamilies. In this piece, we highlight several symposium essays and the lessons learned about elder care in modern families.
The Honor Commandment “Honor your father and mother that your days may be long…” (Exodus 20:12) has long been a private and public value that honors the needs and dignity of our elders.
Protecting the Vulnerable
One key element of honoring an elder is protecting the elder from abuse, especially when the aging parent experiences cognitive impairment. One in 10 Americans over the age of 60 have experienced some form of elder abuse, and 90 percent of that abuse can be attributed to a family member. In their essay, Professors Israel Doron and Charles Foster explore how best to honor the religious commitments of an elder who may not remember her faith identity in the throes of dementia or Alzheimer’s disease. They examine a short case study of “M,” a Jewish woman being cared for by her daughter in Jerusalem. “M” lived with her daughter, who hired a sitter to assist with care several hours a day. This caregiver was not Jewish and in the daughter’s absence, she would sing Christian hymns and read Christian scriptures to “M.” The caregiver defended her actions by saying that “M” smiled and seemed to enjoy hearing these songs and scriptures. Although the family did not press charges, they considered this proselytizing to be “elder abuse.”
This international example highlights one risk of delegating care formally to paid caregivers. Yet there are also risks to delegating care informally to family members, and those risks may be more visible in families with recently added step-relatives, who do not share a life-long family culture. In the U.S., 40 percent of families now include a step-relative. Our research showed that stepchildren lacked confidence in their assessments of what a stepparent valued and what role in the caregiving constellation they were expected to play. Stepchildren worried they would say the wrong thing or make the wrong decision, and be blamed by the biological family of the stepparent. Explicit conversations led by the parent or stepparent about his or her personal values, hopes, and spiritual beliefs helped clarify what was acceptable and what was not. Professional care providers can also take the lead in instigating these conversations. For example, in the U.S., state and federal regulations mandate that hospice organizations employ pastoral counselors who are assigned to patients and families to assess spiritual needs, and rules apply to protect the religious freedom of the hospice clients. Similar professional expectations related to freedom of religious expression should apply to home health workers. Currently, they do not in the U.S. or in the global community.
Looking Outside the Family
Caring for one’s aging parent or elder is not easy, and often requires creative problem-solving in defining why and how one would provide care. In modern times, the face of the family caregiver is also changing. For the symposium, we looked for scholars who have studied populations that have incorporated “fictive kin” well that could help advise aging stepparents. Law Professor Nancy Knauer writes of how the role of “chosen family” plays a critical role in the LGBT community, ensuring that the vulnerable old and dying receive care and support. Unlike the general population who receive care predominately from family members, only 11 percent in the LGBT community receive care from blood relatives. While their experiences show that high-quality care can be given, unless they are legally-appointed as a guardian, friends and neighbors—like step-relatives—do not have access to the protections or benefits of family caregivers. Expanding benefits such as FMLA to include those acting as kin can help facilitate giving our aging and seriously ill citizens access to quality caregivers. As the available pool of family caregivers shrinks, following the lead of communities that have found ways to provide care in creative ways will be critical.
Support from Society is Critical
Honoring parents safely and well requires support from broader society. Palliative care team members Edith M. Meyerson, Diane Meier, and Allison Kestenbaum write about how the interdisciplinary approach followed in palliative care works with patients and families to “understand not only their medical situation but also their wishes, values, cultural background, previous experiences, and quality of life.” The authors draw upon palliative care case studies, where the medical team must assist family members serving as surrogate decision-makers in making health care choices on behalf of a parent. Rabbi Meyerson highlights the role of the chaplain as one that helps to contextualize the families’ personal history so that the clinicians cater their choices and timelines to meet the needs of the family. Routinely, the team met with families to discuss “goals for care.” Their case studies show that public settings, such as the hospital, can provide critical access to professional support that facilitates living the honor commandment.
As we travel near and far to visit family members for holiday celebrations, the challenges of caregiving are near (and dear) to many of us, especially the 17.7 million who are already honoring an aging family member by providing financial, physical, and emotional care. These caregiving tasks can be onerous, yet fulfilling for both the recipient and provider of support. As Guang Xing, a Professor of Buddhist Studies in Hong Kong, writes, “Supporting parents is a great blessing.”
Ziettlow and Cahn wish to thank the staff of the Journal of Law and Religion for the opportunity to edit this symposium volume. The articles referenced above appear in volume 31, issue 2 (2016): 115-226. Amy Ziettlow is ordained in the mainline Evangelical Lutheran Church of America and serves as pastor of Holy Cross Lutheran Church in Decatur, IL. Naomi Cahn is the Harold H. Greene Professor of Law at George Washington University Law School. They are the co-authors of the forthcoming book, Homeward Bound: Modern Families, Elder Care, & Loss (Oxford University Press 2017).