Dementia and consent for sex

Not sure if this goes here, or in the family life forum, but I’m a nurse, and here’s the question.

Situation–aging married couple, one has dementia, one does not–are there any Church teachings (or private opinions) on the appropriateness of continuing sexual relations when consent is clearly dubious?

This is probably more of a woman’s issue because if the man isn’t interested, suffering from dementia or not, the act simply isn’t going to happen.

We had a nursin home patient whose husband would take her out, and they would have sex (she would indicate this to us by gestures after she came back–she was very aphasic). It was clearly painful for her. OTOH, she was always happy to see him, and never cried or shrank away when he visited or showed any fear.

Yes, our social worker got involved but the state laws are extremely vague about this. Both spouses are dead now, but this situation does happen occasionally.

When my mother suffered for eight years with Alzheimer’s, my father would lovingly lie on their bed beside her, hold her hand, kiss her so very gently, caress her arm, leg, shoulder.

She was already in her mid 70s, he in his early 80s, and I don’t think either was thinking about actual intercourse, but I don’t think my mother would have minded his attentions at all. He, on the other hand, would sometimes weep later, because he missed HER, who she had been, the woman he’d loved for half a century or more.

It is the cruelest of diseases.

There was a huge thread about this a couple of months ago. Try the search function.

Found it:

Unless you are in Louisiana, I’m not sure how your state laws could have been vague, as the elements for consent are a common-law principle, not statutory (meaning prescribed by legislation). Where one party has dementia, they lack the capacity to give consent - consent is not dubious, it is absent.

I do not know of any writing in the Church that addresses this situation, but there is discussion in the Catechism regarding the meaning of consent and the obligation of husbands and wives to one another. Certainly someone who is taking advantage of a spouse’s frailty cannot be said to be acting in a loving way toward that person.

It’s dubious because dementia doesn’t happen all at once. It isn’t like one day the person wakes up and doesn’t know where they are or who their spouse is. It happens gradually. Some days they will seem completely themselves, other days they will seem like themselves two decades earlier, some days they can’t remember what happened the day before, or they think that something that happened years ago happened yesterday. That doesn’t mean that they don’t want to consent to relations with their spouse. Obviously, when the disease progresses to a certain point, consent becomes impossible, but there can often be years or even decades of time that goes by where lucidity is fluid.

Consent requires the person to have the capacity AT THE TIME consent is sought. Even if the dementia is flouid, if the person is not capable at the time consent is sought, they are not capable of consenting.

Sobriety is also a fluid state, but once a person is no longer sober, they are presumed not to have capacity to consent, even if they have consented in the past and may do so again in the future once sober.

As a lawyer, I am required to assess the capacity of senior clients who may be suffering from dementia before taking instructions. Even if the person seemed perfectly capable the day before when discussing legal matters, if they are not capable at the time I seek instructions, I cannot take instruction from them.

You may be trained to assess the capacity of senior clients, but most spouses aren’t. If their wife is asking for sex, and clearly knows who her husband is at the moment, but warns him not to wake the baby, and the baby is actually a 53-year-old accountant in Ohio, that’s confusing for a layperson.

It’s somewhat of a different issue from being drunk, because while many married couples are accustomed to having drunk sex with great regularity, the issue of consent doesn’t come up unless the wife complains afterward. This does happen occasionally, but compared to the number of married couples who engage in drunk sex, I think its safe to say that most wives don’t feel violated if their husband has sex with them when they are drunk. I suspect that the same could be said for many couples who are dealing with dementia. The OPs situation is a little different because they are implying that a third party might be compelled to make a complaint on the wife’s behalf, purely on the fact that she has dementia. I think that is a hard call to make unless it is established that the person is in a consistent state on non-lucidity, because how else would they know if the wife was lucid at the time or not?

“Vague” was probably the wrong word–“contradictory” is probably a better one for describing the laws.

On the one hand, we are not allowed to prevent consenting adults from having sex (they shouldn’t be doing it out in the patient lounge, but in the privacy of their room, it’s their own business).

On the other hand, we’re under obligation to protect our residents from abuse.

Like one of the previous posters said, people do cycle in and out of being alert and oriented. Even from hour to hour their mental status can change.

I do appreciate the feedback. Admittedly, this isn’t a situation we see very often, because usually by the time the mind goes, there’s also a wide array of other medical diagnoses and mobility impairments that make intercourse impossible. It does happen from time to time, though.

Thank you for directing me to the other thread.

In the Catholic view, marriage is a state whereby we consent to give our bodies over to the care of one another.

If this is the case, unlike one-night stands, I believe consent is presumed unless circumstances or consequences suggest otherwise.

My reading was that the wife afterwards was not actually complaining about the sex but rather the way it was performed (it hurt…or do you mean psychologically distressed). This suggests the loving husband was not actually aware … and it may have been initally better to draw that to his attention for remedy next time.

Obviously if the situation didn’t change intervention would seem to be called for.

I’m confused as to why anyone would even think that a having sex with a person with dementia would be a great idea.
Sounds selfish to me. I asked my dear hubs, and he was appalled and said he’d never do that to me…despite how lonely or desirable he might think it is. He thinks it’s sad and really selfish.
I agree.
I am continually amazed at how much sex plays into peoples thinking. It seems to control every aspect of some peoples lives. That “me” generation, I guess. :shrug:

And don’t get going on “wifely duty” and Sacramental sex. :rolleyes:
I’m out. Have fun reading that other thread. It was long as I recall.

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