Although Alzheimer's can hit people of many ages, it tends to hit the elderly - and if people weren't kept alive so long with drugs and every kind of preventative safety net, and we were all allowed to die a bit earlier and more naturally, many people would not find themselves in this unspeakable position. This is a real 20th-century problem. This doesn't apply to Maddy, who is only 50, but she can't get away from the facts: she declared to her man when she married him that she would stick by him and forsake all others for better for worse, for richer for poorer, in sickness and in health. Nothing was said about whether barking mad, aggressive, unrecognisable and a completely different personality. Had they discussed it? Probably not. Almost certainly it was one of those things they didn't think to mention, like wills, funerals, what to do if one died before the other, or who would look after the children if they both died at once.
There are a variety of questions Maddy can ask herself. Were the situation in reverse, and she had become the erratic stranger, what would she hope her husband would do? Stay looking after her, faithful and, understandably, deeply resentful? Or have a quietly affectionate relationship with someone else while continuing to look after her? She could also ask herself what her husband would say if he were able to have five minutes of sanity? Would he say: "For God's sake, go ahead!"?
She could also ask herself if she would be completely breaking her promise if she had a loving affair. True, she would be breaking the bit about remaining faithful, but her husband would always come first. She has no plans to leave him, and is continuing to care for him. She could perhaps ask whether this angry stranger is the same man she made the promises to anyway. He has the same name and looks the same, but is he remotely recognisable as the man she married? Has her husband not, in one sense, died already? Is she not a widow in all but law?
Would having an affair be better for her husband in the long run? Would it make her heart lighter, would it stop her slapping his food down in front of him with a bitter face and praying each night that he were dead? Would the affair make the air in the home fresher and sweeter, brushing away the strands of bitterness that would otherwise hang like shrouds from the curtain rails? But if she and her lover were to become much, much closer, would they both find the situation unbearable?
And then she has to have responsibility for herself. Would the affair enable her to become a bigger and better person? Or would denying herself help her to realise herself more? After all, if she were eaten up with guilt, the affair would be a bad move.
I think, however, that she must be honest with herself, and, if she is going to have an affair, own up to herself that she is doing wrong. We all do wrong sometimes, and this is one of the times - like pretending to tell the truth and lying instead, under torture - when, moral or not, to have an affair might be the most sensible decision to taken
What readers say
Your need for affection is important
My advice would be to go for it. Happiness isn't easy to find and, with this degree of dementia at such a young age, you have to face the fact that your husband may not live for much longer. Anyway, as you say, he is not the man he once was. Your needs for affection are as important as his needs for care. You may be better able to care for your husband if you have some life of your own.
But be discreet. Whatever the merits of the situation there will be people very quick to criticise if your relationship with this man becomes public knowledge. This is particularly important if you have children. If they don't live at home and rarely see their father you can be sure they will not understand.
Lastly, if you do decide to have a relationship, enjoy it. Guilt will destroy you. Good luck.
Your husband needs you
A man who has lost his mind needs the respect and faithfulness of his wife as well as nursing care. That is all he has. A wife who has promised to forsake all others and to love and cherish in sickness and in health loses her integrity if she fails her husband when he is most helpless. Of course the wife needs support and respite. She is in a terrible predicament and if she fell into a sexual liaison because she could not cope she would deserve sympathy. But if she sought such a relationship "for what happiness I can get", her selfishness would diminish herself and her husband. The man showing her affection should help her to greatness rather than exploit her weakness.
Beware a sexual relationship
A good supportive friend would be marvellous for you but do beware of the sexual relationship. It can bring emotional pressure and you already have enough to cope with. You could end up feeling resentment towards your husband and may not be as committed as you would wish. Think very carefully before taking this big step. It is support or sex you want? Sex could bring pressures you do not need.
Love helps carers
This is one of the most difficult dilemmas a carer may have to face. As more people are diagnosed with Alzheimer's at an earlier age, the need for carers to see that they too have a future above and beyond the call of duty is absolutely essential. You are doing the best you can for your husband by caring for and loving him. It has to be your decision whether you have an affair because you alone have to live with the consequences. But it may help you cope better with the stress if you can be close to someone else.
As a charity which seeks to support carers, the Society knows they can benefit enormously from the friendship or even love of others and that it reflects in the quality of caring they give. And when your caring days are over it would be a terrible shame to have happy memories of your husband clouded with resentment and regrets about what could have been.
Alzheimer's Disease Society
10 Greencoat Place
London SW1P 1PH
Next week's problem: How should we deal with being sub-fertile?
My husband and I have found we are sub-fertile. It is a combination of problems with both of us. We could try either AID or surrogacy. My husband is dead against it and says that unless the child we have is ours properly he's not interested, but I'm keen to try one option. I'm pretty certain that I could change my husband's mind if I tried. But would it be right to do so?
Comments are welcome, and everyone who has a suggestion quoted will be sent a bouquet from Interflora. Send personal experiences for comments to me at the Features Department, `The Independent', 1 Canada Square, Canary Wharf, London, E14 5DL; fax 0171-293 2182, by Tuesday morning. If you have a dilemma of your own that you would like to share, let me know.