CARR 144-146




Contemporary American Reform Responsa


86. Alzheimer’s Disease


sixty-three-year-old man has been diagnosed as suffering from Alzheimer’s Disease. In nine

months he has deteriorated drastically and now needs constant skilled nursing care. His wife, a

school teacher, has discovered that her insurance does not cover such expenses which are more

than $2,000.00 a month. The couple’s savings will be entirely exhausted in a few years. Medicaid

will not help until nothing except the house in which they live remains. The wife’s lawyer has

counseled her to seek a legal divorce, which will shield her resources so that she may have

some income when she reaches retirement in a few years. Without such a step she will become

dependent upon the charity of her children and the general community. If she takes this step she

will, of course, feel that she has abandoned her husband. His condition has degenerated to such

an extent that he is unaware of his surroundings and does not fulfill his marital responsibilities.

(Rabbi D. D. Weber, Elyria, OH)

ANSWER: These circumstances which you have

described are tragic. Unfortunately, as modern medicine progresses an ever increasing group

within our population reaches an advanced age, and frequently one member is afflicted with an

incurable debilitating disease which slowly destroys that life and drastically affects the life of the

healthy spouse.

Let us see whether a marriage may be dissolved under these

circumstances. Marriage, as the Hebrew designation qiddushin implies, is a sacred act

which brings special sanctity to the relationship established between husband and wife. The

blessings recited (sheva berakhot) indicate the sanctity of the status into which the couple

entered. Marriage and all aspects of family life have been discussed at great length in Jewish

literature since the Mishnaic period. Provisions have, of course, also been made for divorce

(Deut. 24.1 ff) and the Talmudic Tractate Gitin, as well as discussions elsewhere, deal

with causes and the subsequent implementation of divorce.

Among the reasons for

divorce is the affliction of either party with an incurable disease which makes intercourse

impossible or dangerous (Shulhan Arukh Even Haezer, 117.1 ff, 154.1 ff). A wife may

also seek a divorce if the husband is squandering the family assets so that she feels that her

maintenance is endangered (Ibid. 154.3). Although no age restrictions are mentioned in

these discussions, marriages of the young or middle-aged are implied. In other words, these

reasons were not intended to deal specifically with the problems of old age which may, naturally,

lead to illness, impotence and unusual expenses.

We may approach the entire

question from another point of view as noted by Professor Mark Washofsky, to whom I am

indebted, and turn to the duty of one spouse to pay the other’s medical obligations. Shulhan

Arukh Even Haezer (69, 79) obliges the husband as part of the ketubah to provide

medical care for his wife. In our Reform context we would, of course, extend this obligation to the

wife. Paragraph one states that this obligation holds whether the illness is of a temporary or a

chronic nature. Paragraph three deals directly with our problem. It provides an escape in the

event of a long-term and expensive illness (Yad Hil. Ishut 14.17); the husband may set a

limit for her medical bills; should she refuse this offer, the husband divorces her and she

receives the ketubah. Rambam and Caro argue against this arrangement on ethical

grounds (see also Magid Mishneh), but neither denies that the husband possesses this

right. On the other hand, some authorities do deny this right; the Rabad limits the husband’s

power of divorce to a case where the wife is not terminally ill (Ran to Alfasi, Ket. 19a); Solomon

Luria argues that in our day, when the taqanah of R. Gershom forbids divorce without the

wife’s consent, the husband can not compel her to choose between these alternatives (Joel

Sirkes to Tur Even Hazer 79). At any rate, whether a spouse possesses this right or not, it

is definitely not in keeping with the spirit of marriage and its sanctity.

Just as the wife

has the obligation to provide medical care for the husband, the husband is also obligated to

provide economic sustenance to his wife. This is a tenai bet din (Yad Hil. Ishut

12.2 ff). The wife has the right to renounce this support; if she does, her husband no longer has

any claim to her income. The wife in this instance could be encouraged to establish herself in a

state of financial independence; under Jewish law she need not be divorced in order to gain

control of her own finances (Ketubot 58b; Yad Hil. Ishut 12.4). In addition, the bet

din is empowered to seize the husband’s property in the event of his mental incapacity in

order to fulfill her requirement of mezonot (Ibid., 12.17). In this case, the

husband’s “property” would include the ketubah or its equivalent; under Jewish law the

husband’s estate is mortgaged in order to provide the required support for the wife. This also

means that his children as his heirs are obligated to support his wife; this is not charity, but a

debt which is owed her. These thoughts help us within the framework of halakhah, but not

with the current requirement of American law.

We must balance these statements with

our general view of qiddushim and see it in the light of this particular couple. There is

nothing in the question which indicates that they have become estranged from each other. Only

this debilitating illness has led to thoughts of divorce. They surely entered into marriage with the

understanding that they would help each other irrespective of what the future might


Although there might be some technical justification for a divorce from a

halakhic point of view, it would be morally wrong to follow that route in order to preserve

the estate. A divorce may affect the husband despite his current condition and would certainly

affect the wife and children.

We should seek an alternative way to help her both now

and in the future, especially as these questions arise frequently and the social security

administration is generally responsive to such efforts. Furthermore, halakhah also

encourages such practical solutions which will continue the marriage bond and avoid


The wife is duty bound to care for her husband even though there is no hope

of recovery and although it may destroy her resources. We should seek alternative ways to help

her both now and in the future. The lawyer in question should be encouraged to look for other

ways to protect the resources of this client.

March 1986


If needed, please consult Abbreviations used in CCAR Responsa.