What if you are unable to consent to sex you want?


This is an issue that pertains to some of our parents and may soon pertain to us. And it may induce you to think about the nature of desire and love.

In 2009, in a small nursing home in Iowa, a nurse discovered a 78-year-old man in flagrante delicto with an 87-year-old woman; in the nurse’s words, he was “going to town” on her.  Both were very happy; they had often been seen together. When the nurse separated them, she received insults and kicks from the woman.

The nurse contacted the head of the nursing home.  Why? The couple both suffered from dementia. Should they be allowed to carry on this way? Were they competent to consent to sex?

Neither the administrator of the nursing home nor the head nurse saw a problem; the woman was assertive enough to voice unwillingness (and she was observed to be calmer, in general, when she was with him); and the man would not have had an erection if under coercion.  There were no threats, no injuries.  The administrator did not report the incident.

However, when state inspectors heard of it, they charged the home with failing to protect the woman (concluding she had been “sexually assaulted”), and threatened withholding Medicare and Medicaid money, which would have bankrupted the home. The man was discharged.  Too late.  The head of the nursing home and the head nurse were fired, their careers destroyed.  The home was fined. Though the woman’s son had been contacted right after the incident and had found it unobjectionable, once the woman died, the following year, her family sued the home claiming it had failed to prevent her “rape.”

The event has been carefully investigated since, and it is clear that this was consensual, even loving, sex.  Of course nursing homes fear rape of helpless victims. But this is an entirely different issue, one that promises to grow to immense proportion as the 77 MILLION Boomers–who came of age in an era of sexual freedom–grow old, and many enter nursing homes.  Ten million are expected to develop Alzheimer’s Disease.

How are caregivers to deal with people who are confused, incoherent, might not even know who they are with? One school of thought is that they simply do not have the ability to consent, so such sexual activity, fraught with danger, should be prevented. But another school is that people with severe dementia have become, in the words of one observer, “to some degree somebody else.  They’ve lost mental connections with people they loved, with much of their past, but that doesn’t rob them of their desire and their need for touching, for intimacy. Just because they confuse who they’re with, that doesn’t mean it doesn’t give them some pleasure at a time in their lives when pleasure comes at a premium.”

Involving the families of the patients can be very difficult.  Some will be very uncomfortable at the thought of their parents cavorting with people they don’t really know. Whereas others are enlightened.  The husband of former Supreme Court Justice Sandra Day O’Connor had dementia and “took up with another woman in the home he was living in. Justice O’Connor decided that this was good for him, that it made him happy. And she wanted him to be happy.”

One facility, the Hebrew Home in Riverdale, New York, long ago decided to go its own way: It encourages sex and intimacy. Its head says that he thinks its residents aren’t having enough sex.  He “believes none of the great programs they offer their residents can do anybody as much good as having a romantic relationship where somebody wakes up in the morning and can’t wait to see their boyfriend or their girlfriend.”

Some think that people with dementia should not be judged by what they might have thought or felt or done what they would have done earlier in life. Each should be thought of as “a new person who should be allowed to make new choices that makes that new person happy.”

In a sense this pertains to the choices we make while still compos mentis, in middle age: Can’t we choose to leave behind what we once did, and consider ourselves new people with different desires, to be fulfilled in ways we once considered unthinkable?


6 thoughts on “What if you are unable to consent to sex you want?

  1. My mom suffered from Alzheimer’s, and lived in a nursing home until almost 92. Initially, (in her early 80s), it was more dementia, until it eventually progressed. A man in the home was always with my mom when we visited. Clearly, she liked him…. she thought he was her husband. If there were intimacies, we would have been OK with it. Sadly, what we did know was that mom’s beau got her to smoke cigarettes again, after having given them up 20 years earlier, (at age 65). She refused to believe that she had ever quit. She was setting her room on fire, didn’t understand there was a smoking area, and had to be restrained, etc. Sex, hell yeah, we saw them kiss… The smoking, boy did we hate him for doing that to her. He had all his faculties!

  2. Great article. Just feel the need to point out the gross misstatement of “the man would not have had an erection if under coercion.” Many men are sexually assaulted and have their erections used as prima facia evidence that they “wanted it.” No means no, no matter what an uncontrollable physiological phenomenon may suggest.

    Other than that, great article.

    • Thank you. I was assuming, from what the nurse reported, that he was the active party (“going to town on her”), and was not being assaulted or coerced. He had a reputation for being a “ladies’ man.”

  3. At their stage of life when they could be confused, incoherent, and might not even know who they are with, shouldn’t the state of happiness be the ultimate judge? There isn’t many days of enjoyment left for a 78-year-old and a 87-year-old who needs nursing home care. The Creator is taking away their faculties little by little, yet allow them the pleasure of sex for the time being. What gives anyone else the right to rob away the last bit of happiness from these people’s life? And in place of their happiness, what did they give this loving pair instead?

    At 78 years old, in nursing home, the “ladies’ man” should be given a medal, not a punishment. Because none of the family members or the nursing home staff can give these old ladies as much happiness as he can. If we younger people have the right to pursue happiness, why shouldn’t they? Why can’t their sexual behavior be treated the same way as in the case of underage teens’?

  4. “a new person who should be allowed to make new choices that makes that new person happy.” The phenomenon of dementia patients forming new romantic liaisons at care facilities is well-known. There was a wonderful movie, “All of Her” (with a spectacular Julie Christie as the Alzheimer’s patient) where this is one of the main themes. Sandra Day O’Connor’s main concern was the happiness of her husband and kudos to her for expressing this publicly. It’s a sad comment on our Puritan society when joyful consensual sex between the patients above is twisted into being called rape.

  5. Good question, and a superb closer (“Can’t we choose to leave behind what we once did, and consider ourselves new people with different desires, to be fulfilled in ways we once considered unthinkable?) Open-mindeness is key to adapting to the changes that lie ahead, at any age.

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