My Ailing Mom Hates Pot. Do I Tell Her What’s in Her Gummies?

The magazine’s Ethicist columnist on whether to notify an unsuspecting woman that she’s been consuming medicinal cannabis.

My 78-year-old mother has moderate dementia and suffers from mood swings, depression, anxiety, agitation and disturbed sleep. One of her doctors recommended a low-dosage CBD/THC gummy to alleviate these problems. She takes one daily and, combined with other therapies, now experiences more stable moods and better sleep.

The issue is my mother’s conviction that marijuana is for drug addicts and criminals, never mind that medical marijuana is legal in our state. She is so vehemently opposed to marijuana use that she disapproved when my dying sister used marijuana years ago for pain relief from inflammatory breast cancer. I have to lie to her about the ingredients in the gummies, which I casually refer to as ‘‘multivitamins.’’ Is it wrong to give my mother a drug that she would never have voluntarily taken on her own? — Name Withheld

From the Ethicist:

You think your mother’s attitude toward cannabis is irrational. I agree. Generations of government propaganda have doubtless left a mark. But the fact that your mother’s degree of hostility to the stuff is unwarranted doesn’t settle the matter.

Here are a couple of issues to take into account. One is — no surprise — the extent of her dementia, because it affects her ability to understand what you’re telling her about these gummies. From what you say, she would be perfectly capable of understanding that the gummies contain chemicals extracted from cannabis plants, one of which is responsible for psychoactive effects she regards with disapproval. And long before her current condition, you evidently weren’t able to reason with her about the possible medical benefits of THC. In general, we shouldn’t lie to people about the drugs we’re giving them, and your mother would want to know what’s in those gummies. Mild dementia wouldn’t justify denying her that information. But the more serious her dementia is, the more you have to treat her not as someone whose rational capacities must be addressed but as someone whose care is entrusted to you.

Which brings us to a second issue. When we’re acting in the interests of someone who is no longer capable of making reasonable decisions, we may have to bear in mind not just what we think is best for them but what we know they would have thought was best for them. A person who was keeping kosher before she developed dementia shouldn’t be fed bacon, unawares, because her trustee doesn’t believe in Jewish dietary laws. Even if you judge that your mother has passed the point where she can make decisions, you will still have to decide how central her longstanding hostility to cannabis was to her sense of who she was. And you will have to weigh this against the contribution of these gummies to her welfare. Weighing these issues properly involves having a detailed understanding of your mother’s situation; I hope spelling out the issues helps you to do so.

Marijuana Convictions: Gov. Wes Moore of Maryland signed an executive order that forgives more than 175,000 convictions on low-level charges related to marijuana use.

Americans’ Drug of Choice: A new study shows a growing number of people are regularly using cannabis, while frequent alcohol consumption has remained stable.

Risk to Seniors: In Canada, cannabis poisonings rose sharply among people 65 and older after the country legalized the drug, a new study found.

Easing Restrictions: The Biden administration moved to downgrade marijuana from the most restrictive category of drugs, signaling a significant shift in how the federal government views the substance.

I am a liberal woman, slightly older than middle age, living in a predominantly conservative New Jersey community. I recently found myself paired for a round of golf with a woman I have known casually for a few years, a woman whose company I enjoy very much. We have had more than casual conversations in the past, but we never discussed politics. On this day, much to my horror, she was sporting a fancy, sequin-encrusted TRUMP pin on her collar. Quite simply, the pin offended me greatly. Could I have asked her to remove it during our play together? — Nancy

From the Ethicist:

Your fellow golfer was expressing her political views, which is something citizens are entitled to do, even if it involves sequins. You don’t say that this golf course had any rules about personal political signage, and the specific message was clearly what horrified you; it doesn’t sound as if you would have been offended by a ‘‘Yes She Can’’ button. But you’re entitled to express your views, too. You presumably think that it’s terrible to be supporting Donald Trump, because it would be terrible for the country. That’s the sort of thing that fellow citizens ought to be able to discuss, even while they’re studying the lie.

Starting out by saying you found the pin offensive isn’t the best way to get a civil conversation going, though. It makes her, and her choice of accessories, the object of your disapproval. Instead of asking her to remove the pin, then, you might have asked her why she supports Trump. (Someone wearing such a pin can hardly complain if people ask about it.) You could then have explained your own perspective. In a democracy, talking to one another about politics is part of the system.

And if you don’t feel like talking politics with somebody holding a sand wedge? That’s fair. You’d be free to pin to your cap a Kamala Harris button, if that’s your candidate of choice, and then offer a mutual climb down. Recent polls indicate that north of 40 percent of your fellow citizens view Trump favorably. If we’re to play together on the fairway of our republic, we have to be able to take issue without taking offense.

The previous question was from a reader who was weighing whether to help her grandmother perform a civic duty. She wrote: “My grandma has relatively advanced Alzheimer’s disease and hearing loss. At 97, she’s still present enough to recognize her loved ones and enjoy our company, but it’s becoming nearly impossible to communicate with her. In the 2020 general election, she obtained an absentee ballot, and her immediate family members, including me, helped her fill it out. (Her cognition was in decline four years ago, but it was not as degraded as it is now.) … Is it unethical to help her vote again this November? I foresee things playing out similarly to the last general election, in which she performs the mechanics of voting while we advise her.”

In his response, the Ethicist noted: “Anyone may seek — and act on — advice about how to vote. That includes asking other people how they have voted and choosing to do likewise. If your grandmother is still able to check the boxes and sign the ballot as an expression of her choices, she’s just doing what anybody else does. Under those circumstances, she’s entitled to vote with your assistance. If she doesn’t understand what she’s doing, though, she isn’t really voting; voting is the expression of a political choice, and it would be wrong to record a vote that didn’t reflect her actual choices. … When the situation is hazy, my inclination would be to err on the side of helping someone to vote, because voting is such a central form of civic participation.” (Reread the full question and answer here.)

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I’d ask grandma two questions. #1: Who is running for president? If she answers that one correctly, move on to #2. If she doesn’t, walk away. Question #2: Who do you want to vote for? If she doesn’t have a clear answer I’d stop there, unless she expresses a strong interest in voting and you are confident you can present an honest, unbiased difference between the two candidates’ platforms. This whole scenario is a slippery slope toward voter coercion.— Jay

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The letter writer should not “help” her grandmother to vote. Critical as every vote will be in this election, the situation described would produce a fraudulent result. The writer cannot know whether her grandmother’s views might have changed over four years if her dementia had not advanced. I faced a parallel situation with my late father’s charitable giving. When I had taken over writing checks for him, I would ask him whether he wanted to continue giving to charities when their annual appeals arrived. But once his dementia advanced to the point where he could not tell me what he wanted, I stopped sending checks, even though his annual support had been unchanged for years. It would have been unethical to continue. Additionally, what the writer proposes is exactly what makes conspiracy theorists doubt the validity of mail in voting: that the ballot is not the legitimate vote of a registered voter. — Sally

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I read with interest the Ethicist’s entry on helping an older relative with dementia to vote. I feel for anyone in this situation; helping anyone in cognitive decline is difficult at the best of times and good guidance is so limited. I do have one thought to share from my expertise as a psychologist who regularly evaluates individuals with dementia or other cognitive problems for decision-making capacity and guardianship. One of the things that I look for, and advise guardians or caregivers about when necessary, is whether someone’s decisions now are consistent with what their caregiver knows about their values and their prior decisions. The decisions don’t have to be the same but the feel of the back-and-forth should be familiar. The key here is to frame the questions and their choices for them in a way that is consistent with what they have cared about and is not accidentally leading or misleading (especially if you disagree with them on some things). If they can no longer have the conversation in a familiar manner, then it may be that they can no longer make their own choices. — Jeff

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I took my father who was suffering from Lewy body dementia to vote during the 2016 elections. In his case, he had physical issues filling out the ballot, so I received permission to fill out the ballot on his behalf. Before filling out his vote, I made sure he knew all the options, especially for president. Then I held my breath and colored in the oval that I would never personally choose, because I believe that everyone eligible to vote has the right to their choice, even if I disagree. This is a right people died for and I would do it again, because that privilege is one I hold dearly. I applaud those who support others in doing their civic duty, especially for those who might have limitations and are otherwise not able to vote. — V

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I like the Ethicist’s answer, but think it’s important to add something. One of the worst things about dementia is how isolating it can be. Voting is, as the Ethicist correctly points out, civic participation — that is, the act of voting is something that we do as members of and participants in society. Speaking personally, I love the ritual of voting: standing in line with my neighbors, chatting with poll workers, marking the ballot, putting the ballot in the box, getting the “I voted” sticker. No other act reminds me more of my identity as someone who belongs here in this country and this society. The woman who is slowly losing all aspect of her identity can be kept just a tad more attached for just a moment longer by voting. Helping her vote is a kindness. And as a kindness, I can’t think of anything more ethical. — Richard