The ethics of caregiving spouses having intimate relations with someone new while their spouse is in the latter stages of Alzheimer’s disease is controversial, but becoming more common.

Alphonse loves his wife of more than 40 years, and won’t divorce her. His wife has latter-stage Alzheimer’s disease. But he’s only 75, of sound mind and body, and lives with her just three days a week. The rest of the time, he lives with a 68-year-old woman with whom he has intimate relations. His grown children are divided over Alphonse’s extramarital relationship.

Alphonse is part of a growing number of caregiver spouses ranging in age from their 50s to their 90s who are finding romance outside of their marriages while continuing to care for spouses with Alzheimer’s.

Caregivers often face a difficult choice: Either begin an extramarital relationship and risk estrangement from friends and family – and dealing with their own inevitable guilt feelings – or live without a real companion for many years. The trend is prompting religious leaders, counselors, and ethically-minded observers to rethink how they define adultery.

Alzheimer’s support groups are seeing an increase in people who seek to recover the intimacy that they had in their marriages. Alzheimer’s can be like a "living death," creating a profound sense of loss as if the afflicted loved one had died. Spouses may continue to feel their old familiar bond in earlier stages of the disease, but as it progresses, this is usually lost as a long-term sexual relationship changes into a "special friendship."

Alzheimer’s is a thief of cherished memories and often alters a person’s personality in dramatic, adverse ways. Some 5.3 million Americans have been diagnosed with the disease. Most are elderly, but as many as 10% of victims are 65 or younger – ages when the majority of American adults are still vital people in every sense of the word. So-called "early onset" Alzheimer’s compounds the dilemma for spouses, as average life expectancy in the U.S. now exceeds 77 years.

Support group leaders are seeing an increasing number of caregiver spouses begin relationships with one another. An 83-year-old woman began a companionship with a man she met in such a group, and married him after her husband died. Caregivers agonize over their marital vows, and whether seeking a new companion signals a betrayal of their Alzheimer-afflicted spouse. The ethics in such cases are no longer as clear as they once seemed.