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Wendy Perry: Give the person with dementia a voice in discussions about sex and capacity

It can be difficult to know whether someone with dementia has consented to sexual activity. Independent advocates can help find a way through these complex issues.
Dementai_Sex_tile_iStock.jpg

It can be difficult to know whether someone with dementia has consented to sexual activity. Independent advocates can help find a way through these complex issues

In 2015, a 78-year-old man in the United States was charged with third degree felony sexual abuse for having sexual intercourse with his wife who was living in a care home. One of the factors behind the prosecution was that his wifes daughter felt her mother was unable to give consent for sexual activity.

The jury found the husband not guilty , though it was unclear if that was due to the jurys perception of the wifes ability to give consent,

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It can be difficult to know whether someone with dementia has consented to sexual activity. Independent advocates can help find a way through these complex issues


Understanding the ethical issues around supporting people living with dementia who
engage in sexual activity is not always straightforward. Picture: iStock

In 2015, a 78-year-old man in the United States was charged with third degree felony sexual abuse for having sexual intercourse with his wife who was living in a care home. One of the factors behind the prosecution was that his wife’s daughter felt her mother was unable to give consent for sexual activity.

The jury found the husband not guilty, though it was unclear if that was due to the jury’s perception of the wife’s ability to give consent, or a lack evidence that intercourse had actually occurred. The controversial case included so many conflicting viewpoints that it was difficult to hear the voice of the individual living with dementia.

Situations like this often cast practitioners into uncharted waters. Understanding the ethical issues and responsibilities around supporting people living with dementia who engage in sexual activity is not always straightforward. Sexual intimacy is a human need and human right, but as health practitioners we are bound to protect individuals who are vulnerable due to mental impairment.

Advocate support 

The principles that guide our actions are laid out in legislation such as the Mental Health Act 2007 and it is often helpful to check with the Mental Welfare Commission if you have concerns about the way forward. But even with all of the guidance available, listening for and heeding the voice of the individual with dementia can be clouded by other issues. 

These are moments when advocates can be a terrific resource, representing the person with dementia’s viewpoint and addressing the balance between risk and autonomy. 

Professionals and families may struggle with their own feelings and preconceptions about sexuality and about dementia, which may make it difficult to objectively discern capacity and consent. These are moments when advocates can be a terrific resource, representing the person with dementia’s viewpoint and addressing the balance between risk and autonomy. An advocate can help us to filter through the issues where we may struggle to identify what really matters to the individual we are supporting. 

Local organisations who provide independent advocates can be found by visiting the Scottish Independent Advocacy Alliance website, or the Older People’s Advocacy Alliance website for England and Wales.


Wendy Perry is learning and development officer at the Dementia Services Development Centre, based at the University of Stirling

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