Dear Family Advisor

I've sadly and painfully decided it's best to end treatments for my sick wife. Now I face telling my children.

Last updated: Sep 05, 2009

My wife has had dementia for about seven years, and now she has breast cancer. I had to place her in a care home last year because she was constantly hitting me and sneaking out of the house. I lost her for two days and that did me in. I don't want her to get chemo or have her breasts removed. It would scare her and be so hard on both of us. I think it's time I let her go.

I've made my peace with this decision, but how do I tell my children and other family members? They may think I'm just being selfish. I'm exhausted, but I'm also thinking of her. I don't think she would want to live like this. This is by far the worst decision I've ever had to make.

You're in a heartbreaking situation no one deserves. Yet as spouses we sometimes find ourselves grappling with these tough decisions.

First, know that you're not being selfish. It might feel that way because you're so tired and so numb from caregiving. But sometimes coming to the end of our rope allows us to see more clearly and make better decisions. You know in your heart how your wife would deal with all this and how she would feel about it.

You're right that your wife's dementia could make breast cancer treatment difficult for her. On the other hand, for your wife's sake and yours, please fully consider the latest options (chemo, surgery, or both) with her doctors and perhaps a spiritual advisor, counselor, or hospice team, before making your mind up for good. I'm not trying to whap your emotions around or say treatment is the best choice, but I do want you to be at peace when this is all over, and the way to get there is to think about all the angles.

All that said, this is your decision to make on your wife's behalf. Legally, you're her advocate and her voice. It's a private matter, not one that's up for debate among your extended family.

It would be much easier if she had spelled out her wishes in a living or ethical will, or discussed those "what if" scenarios with you. But since she didn't, the burden is on you. Do be sure to clarify your own wishes for later in life so your children will know what you want!

When do you share your decision about your wife with your children? That's up to you. Some couples don't share this information -- ever. I respect this, so long as you realize that the information we most want to keep private has a way of getting out. If you choose this route, don't tell another soul. Or if you do confide in someone, be aware that it could leak out, maybe at an inopportune time or way.

Other couples prefer to put a choice like this out there for everyone's awareness, even if their adult children and others might not agree with them. Neither route is right or wrong.

If you choose to share your thought process, emphasize that you feel this is what your wife would want if she had the ability to decide entirely for herself. Reassure your children of your love for them and for their mom. Pour your heart out. Remind them how lost their mom is and how much the pain of surgery and treatments would scare her. With great love and tenderness, let them know that you're telling them about the decision the two of you have made -- not asking them to participate in making the decision.

Give them time to process everything. If they lash out at you, they're lashing out at death -- they're in pain over losing their mom. Try not to take it personally, and encourage them to talk to someone who can be objective.

Finally, don't let illness keep you and your family from missing your final months or years together. Your goal is to allow your wife to live out the remainder of her days in relative peace and comfort. If you get caught up in a battle with your children, you could forget what's most important. As her beloved husband and faithful caregiver, you deserve the profound experience and closure of being with her as peacefully as possible on the last part of her journey.

If you haven't involved hospice, I encourage you to do so. They will honor your decision, and when your wife is nearing the end, they'll give you the support you'll need to let her die with grace and dignity.