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Have you tried talking to the bio dad about this? I know that sounds a little weird, but he did admit it was tough for him to care for your son. It sounds like he's trying to give your son the best that he's able to do.
One suggestion for the medical part is to ask him to sign a medical power of attorney that would allow your husband to make medical decisions for your son.
What about a legal guardianship? You'd have to check with an attorney to see how that would work. The bio dad could still retain some rights, but your husband would be able to make legal decisions and have a good chance of retaining custody if something were to happen to you.
My friend is a paranoid schizophrenic. He cares for his son when the mom drops him there and decides it's his turn. He knows this isn't the best arrangement, but he wants to be the child's father.
He would gladly give up all his rights and be perfectly happy with supervixed visits that would allow his son to be safe and still have a relationship with him. If the bio dad is not threatened by your husbands place in his sons life, maybe he can help you make arrangements that would insure your sons care and not eliminate him.
A court is not likely to terminate his rights if he pays child support and visits regularly. I'm not sure it's fair to your son either.
As a step parent, my son's mother and I had an understanding that we each had a different role in our child's life. We never talked badly about each other and respected each others time with our son and the importance of those relationships(she wasn't terribly stable either and our son knew that without us ever having to say it to him. He loved her, and she was his mother.)
Anyway, just some suggestions.
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