“What looks like neglect from my perspective is sometimes the best people can do given the tools and capabilities they have,” one of my colleagues said.
The comment was part of a debate about whether inadequate care of an elderly relative rose to the level of homicidal neglect:
When a 94-year-old woman who lived with her son died, the caregiver son – no spring chicken himself – admitted he hadn’t reported his mother’s death until he had cleaned her up.
Under the woman’s clothing, a medical examiner found two large bed sores, one of them bone-deep. She was also dehydrated and severely malnourished.
“How,” he asked his colleagues, “would you certify the manner of death?”
Cases such as this are quite difficult. It’s hard to be consistent; it’s hard to be fair. It’s hard to know what standard to apply.
One of many questions is: Has anybody legally assumed a caregiver role?
If an elderly man who hasn’t been judged incompetent chooses to live in squalor, neglect his well-being and eat only candy bars, his children aren’t accountable when he dies of malnutrition.
In the case under discussion, the woman’s son had moved her into his house. That’s probably sufficient to establish some level of legal responsibility. But I’d want to get the advice of the district attorney before making a homicide determination.
If a legal responsibility exists, how far does it extend? Is it sufficient to make food and water available?
If a young child won’t eat, parents would be required to seek medical care.
If a 94-year-old who doesn’t want to live anymore won’t eat, must her son have her declared incompetent so she can be forcibly hospitalized and tube-fed? Or can he abide by her wishes and watch her die?
Some people say huge bedsores are neglect by definition. But it takes constant vigilance and care to prevent bedsores when a person becomes too weak or ill to turn over by herself.
Maybe a hospital or nursing home can be held to a no-bedsores standard, but what about an elderly caregiver who doesn’t understand the need for constant turning and hardly has the strength to do it, anyway?
Years ago, an elderly woman who was caregiver to her demented husband became so ill she couldn’t leave her bed. So every day, the husband walked several blocks to McDonald’s and bought her a hamburger.
When she could no longer eat, he tore burgers up and stuffed them in her mouth. After she died, he continued to stuff burgers into the mouth of a decaying corpse.
Clearly, he did the best he could.
But in many cases, including that of the 94-year-old mother, it’s hard to know where to draw the line.
email@example.com Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland.