As life expectancy grows, many people are faced with the difficulties of caring for a parent with Alzheimer's disease.1
According to Jewish law, is it permissible to institutionalize such a parent?
This question presents a difficult moral dilemma. On the one hand, the Torah commands us to "Honor your father and
your mother" (Exodus 20:12, Deuteronomy 5:16) and again: "You shall each revere his mother and his father" (Leviticus 19:3), which
seem to be absolute requirements regardless of their behavior. On
the other hand, if the parent has deteriorated to such an extent that
he or she requires being strapped into bed or being drugged or
having a diaper changed, is it "honor" and "reverence" for a child to
do this? Or is it greater honor for an outsider to do so? What about
the emotional strains on the child? How much must he or she bear?
This sounds like a new dilemma but, in fact, the problem of
parents who have deteriorated mentally is mentioned in Jewish
sources as early as the second century b.c.e., and the specific
question raised above has been hotly debated by halakhic
authorities for over 800 years.
The apocryphal book of Ben Sira, dating to the second century
b.c.e., tells us (3:12-13):
My son, be strong in the honor of your father; and do not
leave him all the days of your life. Even if he loses sense, let him
do [all that he wishes] and do not shame him all the days of his
A post-Talmudic midrash teaches much the same thing:
Even if your father's spittle is running down his beard, obey
The Talmud does not explicitly deal with our issue, but it
contains three passages which discuss the erratic behavior of
Dama ben Netina, the gentile "Mayor" of first-century
Ashkelon, was once chairing a meeting of the City Council. His
mother entered, tore off his golden silk cloak, hit him on the head,
and spat in his face - but he did nothing to shame her.
Another Talmudic passage reads:
They asked Rabbi Eliezer: "To what extent must one honor
one's father and mother?" He replied: "To the extent that if he
takes your wallet and throws it in the sea, you should not
shame him" (Kiddushin 32a).
These two Talmudic passages were codified by Maimonides (Mamrim 6:7) and Rabbi Joseph Karo
(Shulhan Arukh, Yoreh Deah
240:3, 8) and they seem to agree with Ben Sira and Seder Eliyahu
matter what you parent does, you must obey him and not shame
But if this is the case, what can a child do if he can no longer bear
his parent's strange or abnormal behavior? This dilemma is dealt
with in a third Talmudic passage which became the basis for most
subsequent halakhic discussion:
Rav Assi [who lived in Babylon] had an aged mother. She said
to him: "I want jewelry!" He made some for her. "I want a
husband!" He replied: "I'll look for one for you." "I want a
husband as handsome as you!" He left her and went to Israel.
When he heard that she was coming after him, he asked Rabbi
Yohanan: "Is it permissible to leave Israel for Hutz La'aretz [the
Diaspora]?" He replied: "It is forbidden." [He asked:]
"Towards his mother - what is the law?" He replied: "I don't
know.".. . In the meantime, Rav Assi heard that her coffin was
coming. He said: "Had I known, I would not have left
Babylon!" [Or: "Had I known, I would not have asked
permission to leave Israel!"] (Kiddushin 31b).
This story is very problematic. Was Rav Assi's mother mentally
disturbed (she seems to be interested in marrying her own son) or
merely crotchety? Can a child run away when he can no longer
tolerate a parent's erratic behavior? And what does the final
ambiguous sentence mean? Did Rav Assi regret abandoning his
mother or is he saying that not only did he act properly by leaving
her, but he was not even required to meet her coffin?
The halakhic authorities interpreted this story in two conflicting
directions. Maimonides (1135-1204) and his followers used it to
legitimate custodial care, while Ra'avad of Posquieres (1120-1198)
and his followers came to the opposite conclusion.
Maimonides codified the story as follows:
If one's father or mother should become mentally disordered,
he should try to treat them as their mental state demands,
until God has pity on them. But if he finds he cannot endure
the situation because of their extreme madness, let him leave
them and go away, commanding others to care for them as befits
them (Mamrim 6:10).
According to the last sentence, it is perfectly legitimate to
institutionalize a parent with Alzheimer's disease, even though this
is not explicitly stated in the story about Rav Assi.
Ra'avad of Posquieres (1120-1198), Maimonides' classic critic,
disagrees (Hassagot, ad. loc.):
This is not a correct ruling! If he goes and leaves him, who
shall he command to watch him?!
Apparently, in Ra'avad's time and place there was no option of
custodial care and, indeed, the first Jewish old age home seems to
have been founded in Amsterdam in 1749.
All subsequent halakhic authorities aligned themselves with
either Maimonides or Ra'avad. The Maimonidean camp,
that since Rav Assi's mother was brought to Israel in a coffin, he
must have ordered others to take care of his mother. Regarding the
practical issue raised by Ra'avad, they reply that the child can hire
someone to take care of the parent. They further state that in cases of
a parent who has deteriorated mentally, an outsider can do a better job than a child for two reasons: First of all, the parent will be
embarrassed to misbehave in front of an outsider. Secondly, an
outsider can raise his voice or physically restrain the parent if
necessary, while a child would never be able to do such things and
is not allowed to do so.
Ra'avad's followers reply that it is clear from the end of the story
(see the first translation above) that Rav Assi regretted having left his
mother and therefore the story proves that custodial care is
Furthermore, if, as Maimonides claims, "others" can
take care of the parent, then why can't the child do so himself since
he has a better understanding of his parent's desires and
idiosyncrasies? In addition, this camp seeks support from R. Jacob
ben Asher (1270-1343) who in his code (Tur, Yoreh Deah 240) quotes
Ra'avad after Maimonides, which seems to indicate his agreement
with the former. Lastly, this camp asserts that Rav Assi's mother
was not mentally disturbed but rather old and crotchety. Rav Assi
left her because he knew he could not honor her requests properly.
But a demented or senile parent needs extra physical care from the
child while his demented requests can be ignored because he no
longer has all of his faculties.
What then are the halakhic options open to a child faced with the
dilemma of caring for a parent with Alzheimer's disease? It appears
from the above analysis that there are three legitimate halakhic
1. A child with stamina and emotional fortitude can follow the line
of thought expressed by Ben Sira and advocated by the Ra'avad and
his camp. They view "honor thy father and thy mother" as an
absolute value which cannot be absolved by the erratic behavior of
the parent. Regardless of how the son feels, he must personally take
care of his parents as commanded by the Torah and must not "leave
[them] all the days of his life".
2. Others may place their parent in a nursing home, following the
example of Rav Assi as interpreted by Maimonides and his
followers. According to this view, a child is not personally obligated
to care for the parent, if he must sacrifice his own emotional health
Responsa in a Moment
40.in the process. They further state that in cases of mental
deterioration, the honor of the parent can be better served by an
outsider who can do things the child cannot do and that the parent
would not want him to do.
3. Yet I believe the preferred halakhic solution is one implied by a
number of the rabbis in the Maimonidean camp - to keep the parent
but pay an outsider to attend to the functions which are
painful or inappropriate for the child to perform. This solution
incorporates the concerns of both Ra'avad and Maimonides. On the
one hand, the parent feels wanted and loved by his or her child, a
feeling frequently lacking in an institutional setting. The parent
functions better at home than in a new and strange environment.
By keeping the parent at home, the child fulfills the commandment
to "honor your father and your mother" in a direct and personal
fashion as demanded by Ra'avad. On the other hand, following
Maimonides, the child protects the parent's honor and the child's
own emotional health by ensuring that a professional is on hand
who can perform functions not in keeping with the honor owed a
parent by a child.
1. Some four million Americans are now afflicted with Alzheimer's disease -
see Newsweek, December 18, 1989, pp. 54-63 and March 20, 2000, pp. 48-56;
Muriel Gillick, Tangled Minds: Understanding Alzheimer's Disease, New York,
2. Seder Eliyahu Rabbah, Chapter (27) 25, ed. Friedmann, p. 136.
3. Two of the three Talmudic passages cited here are aggadic or non-legal in
nature. This is not unusual; halakhic authorities frequently rely on non-legal passages in the Talmud when there is a dearth of halakhic sources.
4. Kiddushin 31a and cf. Yerushalmi ibid., Chapter 1, fol. 61b. According to a
parallel passage in Devarim Rabbah 14:1, she was hasrat da'at - mentally
deficient in some way.
5. Encyclopaedia Judaica, Vol. 2, col. 346.
6. R. Shem Tov ibn Gaon (fourteenth century), in Migdal Oz ad. loc.; R. Nissim
Gerondi (1300-1380), on Rif to Kiddushin, ed. Vilna, fol. 13a; R. David ibn
Zimra (1479-1573) in Radbaz ad. loc.; R. Joseph Karo (1488-1575) in Shulkhan
Arukh Yoreh Deah 240:10; R. Solomon of Chelm (eighteenth century) in Mirkevet Hamishneh to Maimonides ad. loc.; R. Yehiel Michal Epstein (1829-1908) in
Arukh Hashulhan, Yoreh Deah 240:32; and R. Eliezer Waldenberg, Tzitz Eliezer, Vol. 12, no. 59.
7. R. Shlomo Luria (1510-1574), Yam Shel Shlomo to Kiddushin, chapter 1, par.
64; R. Joshua Falk (1555-1614) in Derishah to Tur Yoreh Deah 240; R. Joel
Sirkes (1561-1640) in Bah ibid; R. David Halevi (1586-1667) to Shulkhan
Arukh Yoreh Deah 240:10, subparagraph 14; and R. Samuel Strashun (1794-1872) in
Rashash to Kiddushin ad. loc.
8. The growing phenomenon of adult day care centers enables many children to keep parents with Alzheimer's at home
- see Newsweek, July 2, 1990, pp. 56-58.
9. Midrash Hagadol to Genesis 35:6, p. 597 relates that in the ancient city of Luz
"when a man became disgusted with his father and mother he would
remove them to another city and immediately they would die".
10. For further reading, see Gerald Blidstein, Honor Thy Father and Thy Mother,
New York, 1975, pp. 116-119; Levi Meier, "Filial Responsibility to the 'Senile'
Parent" in Levi Meier, ed., Jewish Values in Bioethics, New York, 1986, pp. 75-84; Barry Freundel, "Halakhah and the Nursing Home Dilemma",
Proceedings of the Association of Orthodox Jewish Scientists 10 (1990), pp. 85-106.