December 2020
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Full text: Tracy, D., Joyce, D., Albertson, D., & Shergill, S. (2020). Kaleidoscope. The British Journal of Psychiatry, 217(6), 731-732. doi:10.1192/bjp.2020.217
Read the full December 2020 Kaleidoscope column in BJPsych for free
Individuals with dementia seek intimacy and companionship just like everyone else, but in the face of cognitive decline there are inevitably concerns about their vulnerability. It is an issue often perceived through the prism of safeguarding against abuse, rather than primacy of a basic human need, not least in settings such as residential homes. Sorinmade and colleagues give a thoughtful account of this often ignored but important issue, including for individuals who lack capacity to consent to intimacy or sexual contact.1 They highlight how sexuality in older people is at best ignored, and often seen as ‘the inappropriate’, but a majority of both men and women with dementia report being sexually active, including over two-fifths of those over the age of 80. There have been some high-profile civil and criminal cases related to this, often with quite complex aspects, such as what should happen when one partner in a long-term relationship loses capacity to consent to have sex. The law in the UK requires that those without the capacity to consent should be prevented from sexual relations, even if there is no abuse, harm or exploitation. The authors propose an instrument – the Advance Decision on Intimacy – to empower individuals to make decisions on how they would wish to express their sexuality when they do lose capacity to make decisions; taking this decision away from the legal authorities or family who might intervene with their preference. This brings the issue back in line with the United Nations convention on the rights of persons with disabilities.