Loss of Empathy and How Such Changes Affect Caregiving Relationships (and Can Inadvertently Affect Law-Related Matters)

During the pandemic,  as our caregiving relationships have probably become more intense because of the physical restrictions on travel, socializing, eating out, etc., I’ve had time to observe and think more about “empathy.”   For several years, even before Covid-19 changed social patterns, I’ve heard friends and family members who are serving as caregivers talk about frustrations they are experiencing with “their” older persons, not just because of increasing physical needs, but because of changes in personality.  While a loved one’s confusion and memory problems are typically associated with Alzheimer’s Disease and other neurocognitive impairments, I also notice how often the caregivers can “forgive” the problems associated with those domains, but are enormously impacted if their loved one no longer is “nice” or no longer seems to be interested in, or cares about others’ moods or needs.  

Loss of empathy is a documented phenomenon in aging generally, and in neurocognitive impairments specifically.  At the same time, loss of empathy seems to be rather weakly studied, or perhaps, more accurately, rather weakly understood.  

Brief excerpts from a review of some recent literature on loss of empathy:

• “Early loss of empathy is one of the core symptoms of behavioral-variant frontotemporal dementia (bvFTD), which is often diagnosed when people are in their 50s.  In contrast, empathy remains relatively intact in people with Alzheimer’s disease (AD).  People with bvFTD are often unaware of the impact of their behavior on others, causing strain in close relationships.  The [2016] study conducted by NeuRA researcher Dr Muireann Irish, found that both the ability to understand other people’s emotions (cognitive empathy) and to share in other people’s feelings (affective empathy) were decreased in people with bvFTD.  People diagnosed with Alzheimer’s however, retained the capacity for affective empathy.” (from a 2016 report by NeuRA, an independent, not-for-profit research institute based in Sydney, Australia).  
• “The question of how aging impacts empathy has important implications for public health because reduced empathy has been associated with greater loneliness, depression, and poorer relationship satisfaction. Socioemotional selectivity theory … highlights the importance of emotional meaning for older adults, and this typically takes the form of spending time with close others. Thus, if older adults experience decreases in empathy, this could have a significant, negative impact on their well-being.” (from Preliminary Conclusions: State of the Research on Empathy in Aging, in Janelle Beadle and Christine E. de la Vega’s article on “Impact of Aging on Empathy: Review of Psychological and Neural Mechanisms” published 2019 in Front Psychiatry).

How do changes in empathy impact decision-making, including decisions about pre-death gifts and post-death bequests?  If differences in the ability to empathize with others are associated with a disease process, should that mean that any corresponding change in gifting could (or should) be legally impacted?  Is loss of empathy a component of reduced legal competency or legal capacity?