Can We Ask Our Son to Go on Weight-Loss Drugs in Exchange for a House?Several years ago, my husband and I purchased a house for our son, with an agreement that he would pay us back. He remodeled it from scratch and has been making his payments to us fairly regularly, though he misses occasionally when other priorities arise. We both agree that we would like to gift him the remaining balance on the house. The money he pays means much less to us than to him, and it would be beneficial for him to have that extra cushion. Our son, however, is morbidly obese, and my husband wants to condition the gift on his getting on a GLP-1 program, which would mean using about half his monthly savings to pay for the medication. I feel that a gift is a gift and you should not extort a grown man, even when it is in his best interests. Your thoughts? — Name Withheld From the Ethicist: It’s not always wrong to attach conditions to a gift. Sometimes the conditions are intrinsic to what’s being given. There’s nothing coercive about a college fund that requires enrollment; tuition support is what the gift consists of. When you give a sibling money for a down payment on a condo, that money had better be put to that use. Nor would it be problematic to tell a relative with an addiction problem that you’ll provide an apartment so long as the person maintains their sobriety. The rationale is that the addict’s choices around substances aren’t fully free. The condition is aimed at protecting autonomy, not constraining it. By contrast, your son is fully capable of judging the evidence and deciding what to do with his own body. His choice not to pursue treatment may be misguided, but it’s his to make, and the condition is unrelated to the gift. What your husband is considering isn’t extortion; withholding a benefit isn’t the same as imposing a penalty. But it’s disrespectful. The implication is that your son can’t be trusted to make reasonable decisions about his own life and body without being bribed into them. Because what’s now called Class III obesity carries serious health risks, your son has good reason to pursue the effective treatments that have become widely available. You, in turn, have good reason to urge him to do so. And no doubt you already have. I imagine that’s why your husband has concluded that your son won’t do what’s necessary to secure a healthier life without pressure. But not only does your husband’s plan treat your son like a child, it also may not be effective in the long run. After all, once the deed is in his name, your son can simply discontinue the program. So consider another gift, the kind where the condition is intrinsic to what’s being given: Offer to defray the costs of his treatment. You have the means, and this way you’d be giving him something without saying anything about how much you trust his judgment. He may still decline. If he does, you’ll need to make your peace with the fact that it’s his body and his life. Thoughts? If you would like to share a response to today’s dilemma with the Ethicist and other readers in the next newsletter, fill out this form.
Readers RespondThe previous question was from a reader who wondered whether it would be OK to cut ties with a friend because of her views on vaccines. She wrote: I have a close friend who recently made a statement about vaccines that is a fringe opinion and, quite frankly, a conspiracy theory. … Given her beliefs, I don’t really want to devote more energy to this friendship. Among our history of disagreements, this one may be the straw that broke the camel’s back. … I told her I wasn’t comfortable hanging out knowing that she’s not vaccinating her children on schedule, given that our kids play together every week. … It’s a health and safety issue for me and our community. Moreover, it really bothers me that she is selfishly choosing to put her children and others at risk when there is no need to do so. As it stands, we aren’t really talking. Our kids see each other much less frequently than before, and I am fine with this. What do you think? — Name Withheld In his response, the Ethicist noted: When you get vaccinated, you do two things at once: You lower your own risk, and you contribute to herd immunity, the collective protection that kicks in once enough of the population is covered. That’s why anti-vaxxers have, for such a long time, been able to free-ride on that majority. It’s a real problem for public health. … Your friend objects that you’re penalizing her for something a stranger could get away with — that your knowing her situation is being held against her. This is just how social life works, though. … On the other hand, there’s also a democratic case for staying in conversation with people whose views you find wrong or even dangerous. … Remaining friends with your anti-vaxxer gives you a chance to change her mind — at the cost, admittedly, of having to hear her try to change yours. But the facts really are on your side. … I should also acknowledge that a friendship you stick with simply for public-minded reasons isn’t much of a friendship at all. If you don’t much value this relationship — and your letter suggests that you don’t — you’re free to let it go. (Reread the full question and answer here.) ⬥ As a mom, a registered nurse and a supporter of vaccines, I can understand the letter writer’s dilemma, and I agree with all of the Ethicist’s points. One factor left unaddressed by both sides is the friendship between the children. The letter writer states that her children played with the other family’s children once a week until the discord between the mothers occurred. This change may or may not be felt strongly by the children, but it could be factored into the decision-making. — Betsy ⬥ I am old enough to have seen polio’s toll in the United States. When I lived and worked in Sierra Leone and Nepal, I saw the horrors of tetanus, typhoid, measles, polio and other diseases. It takes complicated infrastructure and public health measures to create a society in which people can begin to take these safeguards for granted. There will be consequences in the long term, even in the U.S., if infrastructure and public health policies no longer receive support. Being rude and argumentative will not change your friend’s mind about vaccines; however, neither will a lack of consequences for her decisions. Explaining politely to her why you feel vaccines and public health are important enough to merit consequences for your friendship could help avoid much worse consequences for public health in the future. — Theresa ⬥ As the grandmother of a two-year-old who has health risks, I am quite aware that more and more children pose a risk to her now. This risk is very real to our family, as my three-year-old cousin died of the measles in the early 1950s, before the measles vaccine was available. That parents are willing to take that risk, and, even worse, spread that risk to someone else’s child is astonishing to me. Is it worth cutting off a friendship? Surely we choose to devote our energy to people whose values and decisions we respect. How else could we maintain an honest and fulfilling friendship? These are tough times, and we can all bemoan the divisiveness and misinformation, but sometimes lines have to be drawn. Especially when our children are affected. — Gail ⬥ When someone embraces conspiracy claims that have been repeatedly disproven by evidence, it isn’t just a private opinion; it has real consequences for community health. That’s a values choice, and it says something about how they see their responsibility to others. Maintaining a close friendship with someone who rejects evidence‑based public health can be ethically complicated. It’s not enough to say, “My family is vaccinated, so it’s fine.” Public health is collective by definition. If a friend’s choices endanger others, it’s reasonable to question whether that friendship can function in a healthy way. — Clay ⬥ One aspect of the dilemma that didn’t come up in the Ethicist’s response is the emotional cost of maintaining a friendship with someone who advocates for beliefs you think are dangerous. I’ve had this experience, and I found that my blood pressure and anxiety levels were hard for me to tolerate. Ultimately the friendship was not worth the sacrifice of my peace of mind. I wish I could retain both a sense of personal calm and the relationship that threatened it, but I don’t have that depth of character, and I have to live with that. — Diann
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