What Do I Owe My Difficult Mother-in-Law?

My husband’s father passed away not long ago, leaving behind a wife. They were together for decades, but she was never beloved by the three stepchildren, and she never had children of her own. A person she considers a “nephew” lives in the same city we do and encouraged her to move to be near him. She couldn’t stay in her home alone as she was showing mild signs of dementia, and there was evidence, such as unpaid bills, that she was not managing her affairs well. We assisted her in moving across the country, and she is residing in a very nice senior community. We manage her finances and health care and visit a few times a month. The “nephew” does visit her, but nothing more, and has asked for financial support a few times since she moved. She is not an easy person in some regards; for example, she broods about perceived slights and then wants to change her will to cut out the person she feels slighted her (this is a chronic issue). My question is, what are our ongoing obligations, if any, to this person? Name Withheld

Our popular lore is filled with unkind stereotypes about mothers-in-law and stepmothers. (Maybe fathers-in-law and stepfathers get an easier ride because they’re more likely to be seen — in this realm of stock characters — as simply checked out?) You’re writing about a person who, with respect to you and your husband, plays both roles. In reality, relationships don’t reliably adhere to a template. Sometimes things just click; sometimes intimacy develops over time. But life isn’t always allergic to cliché, so here we are.

When you provide people with ongoing assistance, you tend to assume ongoing obligations. In ways I’ve discussed before, when a helping hand is dependably there, it’s only reasonable that we come to depend on it. And so your stepmother-in-law now has a legitimate expectation that she can rely on you to manage her finances and her health care arrangements; she probably also expects that you’ll continue to spend time with her. These are responsibilities that have accrued to you because of what you’ve done for her; they no longer have much to do with the fact that she was married to your father-in-law.

Your letter suggests that her vexing behavior, perhaps especially recently, has been trying your patience. (Personality changes can develop along with dementia, and her unpleasant responses may be growing more frequent.) You’re clearly not happy about how she uses her will as an instrument in her relationships, including, I’m guessing, her relationship with you. And you’re not happy either that she has favored the “nephew” — possibly even financially — in ways that suggest she doesn’t appreciate how much more you and your husband do for her than he does. If thankless children are sharper than a serpent’s tooth, as King Lear thought, our skin can be punctured, too, by ungrateful parents.

Because your existing help for her has created a dependency, though, you can’t just stop looking after her interests. That includes making sure that the “nephew” isn’t exploiting her. But here you should be attentive to what’s motivating you. He may, after all, be a genuine source of comfort and interest in her life, and it’s not unnatural for her to want to express her appreciation of that by helping him out financially. As another Shakespeare character says, “When envy breeds unkind division —/There comes the ruin, there begins confusion.”

No doubt plenty of confusion lies ahead, but you can do your best to steer clear of ruin. Dependency is not an irrevocable condition. It’s just that if you choose to reduce your involvement, you shouldn’t do so suddenly and without making alternative arrangements. However things work out, you and your husband have plainly been enormously helpful to her, and I hope you’re able to take some satisfaction in that.

I am currently helping friends with their severely disabled child. The child needs round-the-clock supervision; this is especially challenging during the night, as someone must monitor the child’s condition at all times. Because of the pandemic and my friends’ precarious financial situation, they are relying on friends to take a night shift, which used to be covered by a nurse. I am now monitoring the child at night once a week, while other friends or family take other nights.

The night shifts are certainly exhausting, but they are mostly doable for me. I am acutely aware, however, that there is no end in sight. And there is a very limited pool of people prepared to give up a night’s sleep. But in helping I feel that I have lost a friendship, as our relationship has become so transactional. I feel as if I am no longer seen as a friend but as a health care worker. I want to stop, but how can I when I know the consequences of stopping will be so catastrophic for the family? I know the child is not my responsibility, but I also know there is no one else to fill the void. Name Withheld

Once again, providing ongoing support is a gift you can’t simply take back. That’s something to consider when you offer help in circumstances like these. You’re entering into a commitment, even if you don’t explicitly make a commitment. You say you know their child is not your responsibility. Yet assisting with the child has now become your responsibility.

It’s also true that dependency doesn’t justify ingratitude. Harried as they are, they should be mindful that yours is an act of a devoted friend and respond appropriately. In the meantime, let’s hope that there is indeed an end in sight; as the pandemic ebbs, they may be able to return to using professional support. If you decide that you don’t want to see them through this crisis, you should try to help find them an alternative — maybe by putting them in touch with organizations, public or private, that could help them look after their child. Most cities have such resources, and your friends may be too preoccupied to do the necessary research.

The rest of us might take a moment to ask ourselves about those whose help we’ve come to rely upon: Are there people we’re taking for granted?

I switched medical practices pre-Covid and was assigned to a male practitioner. My first appointment is coming up, and today I learned from a friend who also uses that medical practice that my doctor has transitioned (or is transitioning) from male to female. Since I have not yet met this doctor, I am wondering about what is appropriate and whether there should be any conversation about the transition. Is there any reason that the doctor should speak about it, even if it is to determine whether I, a cis woman, am comfortable seeing a trans physician?

If my friend was not a patient at this practice and had not forewarned me, I would have been confused to see a female enter the exam room, because I would have been expecting a male doctor. Is this transition process such a private thing that it is inappropriate to talk about it? Obviously, I am in uncharted waters.

Name Withheld

Your new doctor is negotiating a difficult phase of a trans life, which is handling changes in relationships with people the trans person knew when presenting as another gender. You’re someone she hasn’t yet met, and so you will meet her first as a woman. Indeed, it may not have occurred to her that you signed up with her when she was presenting otherwise. She no doubt has already had to deal with questions from patients she knew when she was presenting as male, and I’m sure that it hasn’t always been fun. You can play a small part in our important social transition from transphobia toward trans acceptance by sparing her from having to answer such questions for the umpteenth time. It’s no more incumbent on her to inquire after your comfort level with her identity than it would be for a physician who is Jewish or gay or Black (or all three) to do so. Her gender expression has no bearing on her capacities as a doctor.

Let her decide if she wants to say something. She has the same professional competence as the doctor you signed up for, because she is the doctor you signed up for. She has simply decided that she’s ready to live as the woman she really is.

Kwame Anthony Appiah teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to [email protected]; or send mail to The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018. (Include a daytime phone number.)