Kwame Anthony Appiah teaches philosophy
at N.Y.U. His books include ‘‘Cosmopolitanism,’’
‘‘The Honor Code’’ and ‘‘The Lies That Bind:
Rethinking Identity.’’Let me note, too, that the freight of
words is affected by who’s speaking
them. Patients — perhaps as a result of
sepsis-associated delirium or certain
neurological disorders — may not be in
control of their speech; people who are
subject to Tourette-syndrome-related
coprolalia should not be denied medical
treatment because their words make cli-
nicians uncomfortable. And your patient?
She had a problem with substance use and
employed language that is, increasingly,
stigmatizing of the user. She had no power
over the clinicians who attended to her
and to whose decisions she was subject.
One indication of her lack of status is that
your hospital’s risk managers evidently
decided that the institution could safely
eject her without being held account-
able for the consequences. Though they
didn’t intend to mete out a punishment
that might have amounted to a death sen-
tence, the risk managers eff ectively put
the hospital ahead of the patient.
The duties of medical professionals
are demanding. In wartime, a medic
can have the responsibility of saving the
life of a wounded enemy soldier, even
if the soldier has just killed one of that
medic’s friends. The fundamental clini-
cal imperatives — evolved, collectively,
over generations — shouldn’t be hastily
set aside. Clinicians have duties of care
to patients, even odious ones. And the
more serious the likely consequences of
refusing care, the larger the burdens they
should be willing to accept.
My elderly mother began talking to a
romance scammer on social media a few
months ago. He claims to be building
a bridge in South America and has asked
her for money to support the project. She
has given him tens of thousands of dollars
— her entire savings. Given the convoluted
stories she has told me, I have no doubt
this man is scamming her, and she and I
have fought about her continuing to talk
to him. I love her, and it really upsets me
that this man defrauded her of her money!
Here is the thing, though. She talks to
him via internet chat twice a day, and it
genuinely makes her happy! She is the
happiest I’ve seen her in a long time. She
has had few friends over her life as well
as disappointing romantic partners, and
this is someone she actually enjoys talking
to. Her savings are gone, and I think
she will continue to use her Social Security
Clinicians have
duties of care
to patients, even
odious ones.and pension income to pay her bills. Th at
is, I don’t think she will give this man
much money in the future. Should I keep
trying to persuade my mom to stop
talking to this man, given that I think the
‘‘relationship’’ may end once the money
fl ow stops, and she may feel very sad
about the ending? Should I be worried
about her physical safety if she stops
giving this man money? Our arguments
are really bad, and she defi nitely prefers
I stop talking about it altogether.Name WithheldA lot has been published about romance
scams, including by law enforcement,
and I don’t see that, in the usual course of
things, its victims are in physical danger —
the scammers often live in another hemi-
sphere, for one thing. (You could contact
the F.B.I. if you want further guidance.) But
the fi nancial and the emotional depreda-
tions are very real. Once the money stops,naturally, the scammers move on. There
will be heartbreak ahead for your mother.
You’ve done what you can do. You
have repeatedly pointed out the problem;
you’ve warned her that the rewards of her
relationship are predicated on a lie, and
you no doubt have told her about the pro-
liferation of such scams. She doesn’t want
to go on talking about it. At this point,
I don’t see what choice you have other
than to let her be. As long as your mother
remains competent, it’s up to her to man-
age her dealings with this man. There’s
the minor solace that, as you indicate, the
only ongoing risk is a continuing loss of
relatively small sums of money, and she
has enough to live on. It’s painful to watch
someone you love being exploited, but
you can’t lead her life for her.