Over the past 15 years, I have, sadly, observed at close range the effects of disease on those I love.

There seems to be a tipping point at which the disease starts to win.  It can’t be determined purely as a medical, or scientific, matter.  It is an internal psycho-social-spiritual moment in which that person stops living with, say, cancer, and starts dying from it.  From the outside, that formerly healthy-person-fighting-a-deadly-invasion starts looking and behaving like a sick person who is defined and constrained by the disease.

Even mental disease is that way, in some senses.  For a while, you see your aging loved one as a capable person with some lapses and then, one day, the lapses define the person.  But the psycho-social-spiritual moment doesn’t come from within the sick person.  It comes for the family.  We must determine the tipping point because our loved one cannot.

Worse yet, our loved one doesn’t understand that the tipping point came yesterday, and with it, soon-to-be imposed constraints on our loved one’s autonomy but not, I hope, on his dignity.