Sex, Intimacy, and Consent for People with Dementia

A. Bianchi

In April 2015, 78-year-old Henry Rayhons was charged with sexual abuse after having sex with his wife in a nursing home. Although he and his wife shared a loving relationship, the staff did not believe that she was capable of consenting to sex because of her dementia. This case sparked significant controversy, highlighting the complexities of sex for people with dementia. Who can consent and who cannot? Is it ethically licit to have sex with people with dementia if they cannot consent?

This presentation aims to consider these questions at a time of increasing importance since approximately one million Canadians are expected to have dementia by the year 2030, and many of these people will be sexually active. Enabling intimate relationships for people with dementia is certainly important, but knowing how to balance the need for intimacy while at the same time protecting vulnerable populations who may be unable to consent presents complex challenges.

As a way of responding to these challenges, this presentation considers using a framework of precedent autonomy as a way for people to consent to sex on the basis of prior decisions. The principle of precedent autonomy says that a person with dementia’s prior autonomous decisions ought to be followed as a matter of respect for persons. If we apply a framework of precedent autonomy to the sexual domain, then someone with dementia can be regarded as consenting to sex if their present sexual desires reinforce the sexual values that they held in their non-demented state. So, if someone with dementia valued being in a monogamous relationship prior to their dementia diagnosis, then it would be ethically illicit for them to engage in sex with multiple people in their state of dementia.

Considering people with dementia are often prevented from engaging in sexual acts because of their inability to consent, implementing a framework of precedent autonomy may be a useful way for them to pursue sexual practices that were relevant in their non-demented state. However, there are certain limitations associated with this framework. One of these limitations is that it prevents persons with dementia from pursuing new sexual relationships if these new relations do not align with their prior sexual decisions and values.

This presentation will consider some of the benefits and challenges of using a framework of precedent autonomy for cases of sex and people with dementia. The topic of this presentation will be relevant to both academic and non-academic worlds.