“My parents abused me as a child. I went no contact with them over ten years ago, but now my dad is in the hospital with a serious diagnosis and the discharge planner keeps asking me to be involved. I don’t want to. What are my rights?”

I read the lengthy message several times, feeling an overwhelming sense of dread. I was in the same “no contact” situation with my own aging father. (No contact is a strategy used by many adult child abuse and neglect victims to live separate lives from their abusers. This does not mean they don’t love their parents or family members, but it is often protective and keeps the formerly abused child free from continued harm.) Would someone expect me to be involved in his care as he got older? Was there a legal precedent in situations like this?

Many states have enacted filial laws, which mandate the support of aging or indigent parents by their adult children. California Family Code 4400-4405 states that “every adult child who, having the ability to do so, fails to provide necessary food, clothing, shelter, or medical attendance for an indigent parent, is guilty of a misdemeanor.” There are actually 26 states that have filial laws, including the distant state where my own father lives.

Court systems have previously attempted to obtain payment from adult children to cover nursing home costs and other medical costs. If the parent qualifies for Medicaid, the filial laws cannot be used to force adult children to pay for care. However, if they don’t qualify for Medicaid, a state could try to pursue payment from children, regardless of the connection those children have with their aging parents.

This question brought about a huge discussion in a physician’s group that I am a part of. Many other physicians who came from healthier homes commented that helping a parent, regardless of past wrongs, “would be the right thing to do.” Often, we talk about “what is right” and “forgiveness.” But what if forgiveness harms the family members who have had to figure out how to survive on their own? What if the abuser never even asked for forgiveness nor accepted their wrongdoings? What if there are plenty of excellent reasons to remain no contact or limited contact?

There are two serious issues at hand.

On the one hand, my father was abusive and neglectful, and at 16 asked me to leave the house in his home state. I left and spent the next three years as a homeless teen in California. Without his assistance, I graduated high school, started a family, and began attending community college. I eventually married, transferred to UCLA, and became a high school science teacher. In my early thirties, I enrolled in medical school, took on massive student loans, and struggled to support a family on loan money. During my studies, I took on several part-time jobs to keep food on the table. My husband worked full-time, and between my loans and our employment income, it was still extremely hard to keep the bills paid and pursue medical education. But I graduated and began residency training in family medicine in California in 2014. We matched into a high-cost-of-living area, and most of my residency paycheck went into housing costs. We continued to struggle financially until I became an attending physician in 2017.

My dad frequently bragged that he never paid a dime towards my education and was not involved in my life or the lives of his grandkids. When I cut off contact with him in 2017 at the urging of my children, who recognized the toxic relationship long before I did, he never questioned it. Five years passed, and he never called or asked why I stopped communicating with him. That speaks volumes to me about what our relationship was … and wasn’t.

But on the other hand, he’s now showing signs of dementia. He’s in his late seventies, and his health is declining. Whereas he’s spent years of his life telling me I’ve “misremembered” events of my childhood and teen years, he likely doesn’t even remember the harm he caused. He probably doesn’t recall having me forcibly detained and placed unnecessarily in a psychiatric hospital at 11 years old, where I experienced abuse and forced medications. He probably won’t remember that at 13 years old, I ran away from home to escape the threat of being sent back to the hospital, a wilderness camp, a group home, or any other place he wanted to send me. He never liked to talk about the fact that he pressed charges against me for stealing money from him when I ran away at 13, which resulted in an up to 2-year sentence at the maximum security juvenile prison in North Carolina. No, he won’t remember those things. But I do. They changed who I became as a mother, former teacher, physician, and advocate for the rights of young people. And because of those things that I do remember, I absolutely cannot be involved in his care now.

As a physician, society would likely expect me to be able to financially support my aging parent. I’ve heard similar concerns about frail, elderly patients who are hospitalized and have no family members involved in their medical decisions or their post-discharge planning. I strongly believe there is no “one-size fits all” approach to managing complex families like mine or many of the patients I’ve cared for over the years. Wherever significant childhood trauma has occurred, adult survivors have every right to live their lives as they see fit, whether it includes their abusers or not. I would not be willing to remain tethered to someone who caused me such significant harm, regardless of what others may think is right or wrong.

We should all think carefully about the family dynamics of aging adults. Often, there are reasons why family members have cut off contact, and their needs matter, too.

Sheryl Recinos is a hospitalist and author of Hindsight: Coming of age on the streets of Hollywood.