Ménage à Trois: Sex, Dementia and the Law

There are events in life that are more colorful than the black and white reality of our moral principles. The monochrome reality of our moral world is sometimes outshone by the Technicolor nature of reality. People that are suffering from dementia expose some of these layers of moral predicaments.

The recent case of a husband assumed to have continued to have sex with his wife when she was in a nursing home brought to light the spectrum of colors of this issue. This is the story of Donna Lou Young andHenry V. Rayhons in Duncan, Iowa. A week after her death at the age of nearly 79 Henry was charged with raping Donna at a nursing home where she was staying. As with rape charges there are tests and exposure of behavior that was intended to remain behind closed doors in the bedroom. Henry was eventually found not to be guilty, but the emotional damage diminished his dignity, his humanity as a husband. This case raises questions about who you are when you are diagnosed with dementia, and more importantly, what the law allows you to do, or allow others to do with you.

That same week there was the case of a lord of the House of Commons with enough evidence of child abuse but was not brought to court because he had dementia. Greville Janner, now Lord Janner, was a very active pedophile alleged with 22 sex offenses of indecent assaults and buggery during 1969 and 1988, involving nine children in state-run children’s homes. Despite remaining an active member of the House of Lords still attending meetings, the director of public prosecutions, Alison Saunders—similar to the U.S.  city/district attorney—found it “against the interest of the country” to prosecute a likely pedophile because he was suffering from dementia.

Dementia can shield as well as expose you to the imperfections of the law. But sometimes the problem is not the person that is suffering from the disease, but their loved ones. Sex in nursing homes brings about that added dimension of ageism. The monochromatic belief is that older adults should not be having sex, especially those with dementia. But this attitude denies people's history, experience, expression and dignity.

The case at Windmill Manor in Itoralville, Iowa, where two patients with dementia become emotionally and physically involved, to the ostensible benefit to both, resulted in the couple becoming separated and the managers at the nursing home losing their job. In contrast, when there is an acceptance that dementia is a disease that erodes your memory and who you are, there is acceptance of such physical foibles. Supreme Court Justice Sandra Day O'Connor acceptance of her husband’s affair with a female resident at the same nursing home is a Technicolor reality. A situation that has been immortalized in Alice Munro's 1999 short story "The Bear Came Over The Mountain." Sometimes there is an appreciation that sex might be one form of communication remaining among many dead forms of expression. If you we appreciate and understand this, how far will we go to satisfy the needs of a demented patient? Sex and religion head butt often, but when it is your loved one would you support their needs.? The Australian case of a daughter of a dementia nursing home resident who procures a sex worker for her father with the blessing of the nursing home staff might seem liberal, but what if the nursing home was one of many run by religious organizations?

These are not easy moral decisions. And there are more Technicolor layers that await to become exposed. The LGBT older adults who have to go back in the closet when they enter an assisted living facility or a nursing home. Or the ostensibly heterosexual resident who suddenly (to the caregivers) develops an interest in same-sex residents. What if the other person was not a resident but a caregiver?  And not ignoring the sexual abuse of residents with dementia by their caregivers. 

The law has always meddled with sex, and it has always been on the wrong side of history. Sex with dementia would prove a tricky moral and legal issue. In a nationally representative study of more than 3000 U.S. older adults with dementia reported that 59% of the men and 51% of the women were sexually active when they had a partner. Overall, whether they had a partner or not, 46% of the men and 18% of the women with dementia were sexually active. The certainty is that the Technicolor of the reality of sex among those diagnosed with dementia will continue to confound us and to make us relinquish our monochromatic morals for a less rigid one with many hues.

© USA Copyrighted 2015 Mario D. Garrett

References
Lindau, S. T., Dale, W., Feldmeth, G., Gavrilova, N., Langa, K. M., Makelarski, J. A., & Wroblewski, K. (2018). Sexuality and Cognitive Status: A US Nationally Representative Study of Home‐Dwelling Older Adults. Journal of the American Geriatrics Society, 66(10), 1902-1910.