Ride For Life: Devastating diseases force some couples to 'divorce' to qualify for health care

Letter to THE ETHICIST (An advice column published in the NY Times):

My husband and I, in our 50's, were married nearly seven years ago. Last year, he was given a diagnosis of early-onset Alzheimer's disease. In our state, all but about $90,000 of our combined assets, excluding house and car, would have to be spent before he could qualify for assistance.

I am considering a 'Medicaid divorce' (that is, in name only) so he can receive treatment without running through my modest savings. We both dread the divorce, and I don't want to cheat Medicaid, but I don't want to be driven to poverty. Is such a divorce ethical? B.V.C., Seattle

THE ETHICIST replies:
People marry late in life for various reasons, but the pursuit of financial ruin is not one of them. So it is through divorce, paradoxical as it sounds, that you can best honor your marriage vow to cleave to your husband for better or worse. Preserving your small savings will be enormously beneficial to you both.

I can understand his fear that divorce could be the prelude to your abandoning him, but you can help him most by offering tenderness and reassurance, not by joining him in penury. If you become loving but unmarried companions, your ethical obligations to one another will not be transformed.

It is a grim irony that while the president touts marriage as the road to financial security, your staying married would mean a descent into poverty. What you are contemplating is not the exploitation of a legal loophole but adherence to the regulations governing Medicaid. But you should seek legal and financial advice: besides divorce, there are other options to consider, including, for instance, transferring some assets to your children (if you have any) or protecting your assets through annuities or trusts. Done with respect for the law and compassion for your husband, such actions, divorce included, are prudent and ethical courses of action.

Ultimately, the question is who should pay for your husband's care: Medicaid or you, the late-in-life spouse? To me the answer is both. You should assist him but should not be utterly impoverished. And Medicaid should be reformed so as to spare you this painful dilemma. Medicaid rules envision a couple in a lifelong economic partnership. While this is true of many couples, it is not the case for those like you who marry late in life.

Yours is a situation in which an individual moral goal -- to behave honorably toward both your spouse and the law -- is best facilitated through political action.

Both major parties must make changes, embracing measures to protect the assets of middle-class seniors and taxing the assets of the rich (including through the estate tax) to provide all Americans with catastrophic medical care.