Can you consent to sex if you have dementia? Researcher studies dilemma

Caregivers are unsure and uncomfortable with the topic, but a researcher in Waterloo is looking at whether people with dementia can consent to sexual activity. 

And it's time to start talking about it, according to Andria Bianchi, a PhD candidate in applied philosophy at the University of Waterloo.

Bianchi's dissertation focuses on sex, dementia and consent, and she said has been interested in dementia and decision making for a long time.

"I think there is a stereotype that people with dementia are not sexual beings. But they absolutely are," she said in an interview with CBC Kitchener-Waterloo's The Morning Edition host Craig Norris on Tuesday. "There are many cases that back this up, that people with dementia are sexual persons and they absolutely are interested in engaging in sex."

Bianchi spent time in two Toronto hospitals on placements as part of her program. She found that many doctors, nurses and caregivers weren't sure how to address the issue of consent, according to a profile on the university's website.

How to determine consent?

Bianchi said she has developed three ways to determine consent.

"The first way that I'm looking at is to consider a person's prior wishes and values in relation to their present decisions regarding sex," she said. "If someone with dementia was a nun who valued maintaining a life of chastity then it might be ethically illicit or concerning for her to engage in sex with dementia."

Bianchi's second approach is to actually encourage autonomous decision-making from the person with dementia.

"This approach would involve family member and caregivers perhaps supporting or facilitating a decision making process in terms of sex," she said.

"The third approach is to prioritize happiness or pleasure above typical forms of sexual consent in terms of how they're communicated," she said, citing former U.S. Supreme Court justice Sandra Day O'Connor, whose husband, John, pursued a new intimate relationship with another dementia patient in his long-term care home. Media reports have indicated that John no longer recognized Sandra at that point, and that when his new romance started, O'Connor was pleased to see her husband happy again.  

Protect patients from harm

Bianchi cautoned that it is importance to balance a person's need to have sex with protecting from them from harm and sexual assault.

"I think that sex is a taboo and moralized topic that people don't like speaking about often times and it brings some discomfort to people," said Bianchi. 

"I think that we need to be more comfortable speaking about this openly."

"By the year 2030, 75 million people are expected to be diagnosed with dementia and many of these people will be sexually active," said Bianchi.