An early dementia diagnosis does not mean you and your partner can't – or shouldn’t – continue to enjoy a meaningful sex life. As dementia progresses, however, you and others may question if your partner is really consenting or is simply unable to say no.
“Physical intimacy and dementia can present ethical concerns, both personally and legally,” says Danielle Inman, Community Relations Director at YourLife™ of Pensacola, a Memory Care community in Pensacola, Florida. “Complicating matters of consent might be an increased desire in sexual activity as dementia progresses – but not the ability to recognize their spouse – or medical issues that the person doesn’t fully understand.”
In this post, we’ll address some ethical and legal considerations of physical intimacy and consent among people with memory loss.
SHOULD YOU OR SHOULDN’T YOU: ETHICAL CONSIDERATIONS
Determining your partner is a willing participant is essential. Most importantly, of course, it will prevent you from causing unintentional physical or emotional harm to your partner. Proving your partner has the capacity to consent can also help protect you from abuse accusations. Some considerations include:
- Recognition. Does your partner consistently recognize you? Do they often think you are someone else, perhaps a previous spouse?
- Interest. Do they initiate intimacy or reciprocate affection? Is it genuine, or do you suspect a lack of judgment caused by their dementia?
- Exercising choice. Is your partner able to decline sexual contact, either verbally or nonverbally? Do they display signs of embarrassment, emotional withdrawal, or sadness during or immediately after intimacy?
- Vulnerability. People outside your relationship may question to what extent your partner is susceptible to exploitation. If a family member, healthcare, or legal professional asks, will your partner express a desire to be intimate with you? Can they answer questions about your relationship? Will they report feeling safe and respected?
If the relationship is new and/or you are not married, is your partner able to understand the risk of sexually transmitted diseases? Do your partner’s adult children think their parent would have opposed the relationship or sexual intercourse outside of marriage prior to their diagnosis? Has dementia changed your partner’s beliefs or preferences?
- Previously declared incompetence. Does your partner lack the legal capacity to make informed medical decisions? If so, you or others – including your partner’s power of attorney – may assume that automatically makes your partner unable to consent to sex. But in America and other countries, all adults are presumed to have the capacity to consent to sexual activity, absent evidence to the contrary.
But how does one prove ‘evidence to the contrary?’
CAN YOU OR CAN’T YOU: LEGAL CONSIDERATIONS
There’s a lot of gray area when it comes to the ethics of sex and dementia because the law doesn’t provide all the black and white answers. Since it’s complicated, we feel it’s best to provide an excerpt from the American Bar Association Commission on Law and Aging – American Psychological Association’s Assessment of Older Adults with Diminished Capacity: A Handbook for Psychologists.
Generally, the law recognizes three factors that must be analyzed in determining legally sufficient consent: (1) knowledge of the relevant facts relating to the decision to be made; (2) the mental capacity to realize and rationally process the risks and benefits of engaging in sexual activity; and (3) voluntariness, meaning the absence of coercion and the presence of a realistic choice between engaging or refraining from the activity.
Most states define ‘mental capacity’ to mean that the person cannot understand the nature of sexual conduct – that is, the person does not know either the physiological aspects of sex or the possible consequences of sexual activity, such as ... the contraction of sexually transmitted diseases.
Some states require an added element of appreciating the moral dimension of the decision to engage in sexual conduct, although following those moral notions is not required. Thus, the individual may need the capacity to appraise the nature of the possible social stigma or taboo associated with sexual intercourse outside of marriage.
Regardless of the legal standard, an even greater challenge is the lack of a clear standard for the assessment process, i.e., the evaluative criteria and tools to be used in the assessment of capacity to consent to sexual relations.
When even the law isn’t clear on how to assess a person’s capacity level when it comes to sexual consent, it’s no wonder couples struggle with this issue.
“Couples who consent to a physical relationship are urged to reevaluate the person’s ability to consent as dementia progresses and other changes in cognitive, behavioral, or physical health appear,” says Inman of YourLifeTM. “Those in long-term relationships may be able to tell when it no longer feels ‘right,’ but older adults in relationships that developed post-diagnosis won’t always have a good baseline for gauging their partners’ changing behaviors or attitudes towards sex.”
For more tips on intimacy and other sensitive topics with dementia, give YourLife™ of Pensacola’s dementia experts a call today. 850-290-2632.
The Memory Care Your Loved One Deserves
Offering the very best in Memory Care, YourLife™ of Pensacola was designed specifically with residents in mind. We’ve created a community where residents define their own lifestyles, informed by their preferences, needs and story while having peace of mind with 24-hour support.
Because we focus solely on Memory Care, all our resources and attention cater to each resident’s needs while providing unmatched peace of mind for families. Our licensed nurses and YourLife™ Personal Care Specialists are on site 24 hours a day, seven days a week, to provide personally inspired care and support, no matter your needs. With such dedicated care, our residents have the support they need to live as independently and engaged as possible.
At YourLife™ of Pensacola, YourStory comes to life. Whether you want to enjoy our exclusive activities and YourStory programming, spend time exploring our services and amenities, relax in our easy-to-navigate Memory Care neighborhoods and living areas or try something new, the choice is entirely up to you.
Call us at 850-290-2632 for more information or to schedule a personal visit today.