Extra-Marital Sex: Sex by the Demented in Nursing Homes
On August 8 2011, I started a thread here titled "Extra-Marital Sex: Spouse of the Demented Marital Partner" and I got some interesting visitor responses. Today, I would like to switch the topic around a bit to consider extra-marital sex, not by the competent spouse but by the demented spouse living in a nursing home with a sex partner who is also demented. Is this ethical? Is it even legal? Should this activity be prevented by the nursing home? Can the demented still have the capacity to make a decision regarding whether they should engage in sex with another nursing home resident? If one or both are married to a spouse living outside the nursing facility, is it marital infidelity and should be prevented?
To learn a bit more on this subject, the issue was presented yesterday on NPR "All Things Considered". The audio and text is available at NPR .
Bryan Gruley, reporter-at-large for Bloomberg News, talks with Melissa Block about his two-part feature story on sex and nursing home patients with dementia. One key question is whether those with dementia are truly able to consent. How nursing homes deal with this, or not, is increasingly becoming an issue as baby boomers enter nursing homes.
Is such apparently consensual sexual activity between the demented an ethical issue? Is it a legal issue? So, if you were operating a nursing home, what would be your responsibilities in this matter? Would you stop it or allow it to continue, considering it would be humane and even therapeutic? ..Maurice.
Graphic: From Google Images.
ADDENDUM 7-26-2013:
Here are the links to the two Bloomberg News articles by Bryan Gruley
Article One Boomer Sex With Dementia Foreshadowed in Nursing Home
Article Two Sex in Geriatrics Sets Hebrew Home Apart in Elderly Care
Graphic: From Google Images.
ADDENDUM 7-26-2013:
Here are the links to the two Bloomberg News articles by Bryan Gruley
Article One Boomer Sex With Dementia Foreshadowed in Nursing Home
Article Two Sex in Geriatrics Sets Hebrew Home Apart in Elderly Care
posted by Maurice Bernstein, M.D. @ 9:13:00 PM
13 comments
13 Comments:
I wrote a review on this once.
Miles SH, Parker K. Sexual Intimacy in the Nursing Home: Iatrogenic Loneliness. Generations 1999;23:36-44.
I worked as a volunteer in a nursing home for a short while and I understand how non-coherent some people become. That said, if I were a nursing home administrator, I think generally, consensual activity between two demented people is ok and I wouldn't stop it...unless there were mitigating circumstances, of course. I would be reluctant to deny the elderly the pleasure of sex in the moment, and even the freedom of the emotional baggage that can accompany a sexual relationship, at any age. I'd want to recognize it as a natural and normal human function and try to let them have the enjoyment.
Is your concern that someone might not normally consent if they realized who it was they were having sex with? So long and they don't know, and they are happy, why not let them be free to imagine it's someone really perfectly, terrific? Happiness isn't always easy to come by. I wouldn't interfere. Or are you more concerned about a risk of a VD?
This is completely unethical. Yes, nursing homes should do whatever they can to prevent men and women who are not married to each other from having extra-marital sex. If I was a nursing home administrator, I would separate men and women from each other who were not married to each other. I would have separate wings. It is sad about how morals are declining in America and we need to do whatever we can do to prevent this immoral activity. Yes, it is marital infidelity when a demented person has sex with someone who is not her/his spouse. Dementia is not an excuse to participate in this immoral activity.
Misty
Misty, can't you look at the sexual activity as therapeutic and beneficent for each of the two demented parties? Do you look at dementia as a total loss of all "good feelings" equivalent to general anesthesia? Or does the concept of "immorality" within marriage trump any attempt a allowing a "good" to someone in need. Whose benefit should we consider most important, that of the demented patient or the patient's spouse? ..Maurice.
Mo, I think misty had her tongue in her cheeks.
Dr. Bernstein,
I certainly do not see the sexual activity as therapeutic and beneficial for demented patients at all. A demented person should only have sex with his/her spouse period. I cannot believe that this discussion was even started to be honest. There is nothing good about immoral activity at all. What do you think about drunk people having extra-marital sex because they did not know what they were doing and they wanted to “feel” good? The demented patient should make every attempt to remain faithful to his/her spouse no matter how hard it is. Dementia is not an excuse to let go of the vow to stay faithful to one’s spouse. Think about all of the STDs that could be contracted by allowed demented patients to have sex.
Based on this article, it seems like morals do not matter if a person is demented. My great-grandmother who had Alzheimer’s Disease stole some things from the store. Her mom (my grandmother) caught her and did not let her continue the behavior. I’m sure my great-grandmother felt good to steal those items, but that does not make it right.
Misty
Misty. what makes an action "right" when the act is one for human pleasure? I suppose one can say it is "right" if the act is legal and no one is harmed. Sexual intercourse itself within a nursing home is certainly not illegal if carried out between consenting adults. After all, it is a "home".
"Consenting", particularly if both adults are severely demented might be argued difficult to prove but certainly if one adult is unconscious, there is obviously no consent but otherwise without apparent rejection actions, despite dementia, one can argue this could represent consent.
If either party is currently married to a spouse living outside the nursing home and the dementia obscures any memory of marriage to that individual, shouldn't the response of the demented be the property of that party and not that of the spouse of the demented individual?
Would the "faith in marriage" argument still allow the spouse to enter the nursing home and have sex with the demented marriage partner if the partner does not recognize the spouse or that the two are currently married? Doesn't that argue against the "vow of marriage".
You write "I cannot believe that this discussion was even started to be honest." And yet, though sexual activity between the demented in nursing homes has been an issue going on for many, many years, as you can see by the results of the investigation noted by Gruley on NPR's "All Things Considered", there still is controversy as to what is the appropriate ethical and legal response to this nursing home activity. ..Maurice.
Maurice & Misty, There is room for some compromise on this issue.
Most dementia patients have a family advocate (who has power of attorey) who would want to perform with the same mindset as the patient and look to the patient's own personality and what they would have wanted before they became ill.
While this doesn't fulfill the "in the moment" needs of all dementia patients, because they don't remember the past and they live "only in the moment", not everyone would be pleased with the decision.
Not everyone in a nursing home is married, many are widowed and it could be said that the medical/mental needs of the patient come before any moral issues on the subject.
This issue is similar to the abortion issue but more benign in it's nature. While nobody wants to have an abortion, sometimes, people feel they must and the religious issues of some should not dictate what is good for all. Everyone who feels otherwise is then losing their rights.
The real challenge is for someone who has a strong moral compass on the issue of sex, this discussion should be held with a patient in early stages so that they can make that decision, just like any other.
belinda
belinda
I can't believe this would be considered an option. So now I'm going to add to my living will, (in case I get dementia) "I do not want to have anyone touch me in a sexual way, even though I may appear to consent to such activity".
Robin
Ah Robin, you left out an alternative request for your living will when you end up demented in a nursing home:
"If I am found initiating a sex act with another patient of the home even though that individual appears to consent to that activity, I demand that I be physically restrained, further contact prevented and that the staff apologize to that individual and to the individual's family."
Hmmn.. that should take care of most of the possibilities which could be included in that living will. Or does anyone have any further suggestions? ..Maurice.
Oh! Again, I do! How about if the demented individual in the nursing home is found masturbating. How about writing living will request to prevent that activity if when the individual in an undemented life was following Catholic religious doctrine as an example. From Wikipedia: "The Catholic Church teaches that "Masturbation constitutes a grave moral disorder" and that "both the Magisterium of the Church—in the course of a constant tradition—and the moral sense of the faithful have declared without hesitation that masturbation is an intrinsically and seriously disordered act.Cardinal Seper, Franjo (2005-12-29). "Persona Humana: Declaration on certain questions concerning sexual ethics". § IX. The Roman Curia. Retrieved 2008-07-23."
If you were writing that living will order, how would you explain what you wanted done by the nursing home staff if they found you masturbating?
Complicated, confusing and ??perhaps grossly unethical to put the responsibility of all the personal variations of sexual activity by a demented resident onto the nursing home staff. That is why, in my opinion, there is currently no final consensus as to what actions, if any, the staff should take...Maurice.
Your detailed added directives to a living will help give light of the ridiculous nature of such consideration. If I found out the staff or administrator allowed anyone to touch my mother, in a sexual way, while in a nursing home, I'd be horrified ...and in my humble opinion, a state prosecutor would have a field day.
~Robin
Here are the links to the two Bloomberg news articles by Bryan Gruley which formed the basis for my starting this thread.
..Maurice.
http://www.bloomberg.com/news/2013-07-22/boomer-sex-with-dementia-foreshadowed-in-nursing-home.html
http://www.bloomberg.com/news/2013-07-23/sex-in-geriatrics-sets-hebrew-home-apart-in-elderly-care.html
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