Journal Article

Advancing an Ethic of Embodied Relational Sexuality to Guide Decision-Making in Dementia Care

Alisa Grigorovich and Pia Kontos

Edited by Rachel Pruchno

in The Gerontologist

Published on behalf of The Gerontological Society of America

Volume 58, issue 2, pages 219-225
Published in print March 2018 | ISSN: 0016-9013
Published online December 2016 | e-ISSN: 1758-5341 | DOI: https://dx.doi.org/10.1093/geront/gnw137
Advancing an Ethic of Embodied Relational Sexuality to Guide Decision-Making in Dementia Care

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  • Geriatric Medicine
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Abstract

Sexuality and intimacy are universal needs that transcend age, cognitive decline, and disability; sexuality is a fundamental aspect of the human experience. However, supporting sexuality in long-term residential care presents ethical challenges as this setting is both a home environment for residents and a workplace for health practitioners. This is particularly complex in the case of residents with dementia given the need to balance protection from harm and freedom of self-determination. Despite such complexity, this challenge has received limited critical theoretical attention. The dominant approach advocated to guide ethical reasoning is the bioethical four principles approach. However, the application of this approach in the context of dementia and long-term care may set the bar for practitioners’ interference excessively high, restricting assentual (i.e., voluntary) sexual expression. Furthermore, it privileges cognitive and impartial decision-making, while disregarding performative, embodied, and relational aspects of ethical reasoning. With an interest in addressing these limitations, we explicate an alternative ethic of embodied relational sexuality that is grounded in a model of citizenship that recognizes relationality and the agential status of embodied self-expression. This alternative ethic broadens ethical reasoning from the exclusive duty to protect individuals from harm associated with sexual expression, to the duty to also uphold and support their rights to experience the benefits of sexual expression (e.g., pleasure, intimacy). As such it has the potential to inform the development of policies, organizational guidelines, and professional curricula to support the sexuality of persons with dementia, and thereby ensure more humane practices in long-term residential care settings.

Keywords: Ethics; Dementia; Sexuality; Long-term care; Relational citizenship

Journal Article.  4748 words. 

Subjects: Geriatric Medicine ; Biological Sciences ; Psychology ; Care of the Elderly ; Gerontology and Ageing

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