Jane McCredie: An age-old right to sex

AFTER my grandmother fell in the street and broke her nose, I was with her in hospital when a plastic surgeon came into the room.

He inspected the damage, turned to an attending colleague and, without acknowledging the patient at all, said: “It wouldn’t be worth operating.”

My grandmother hauled herself up in the bed, face still bloodied from the fall. “Why?” she demanded. “It may not be much of a face, but it’s all I’ve got.”

After a moment’s stunned silence, the surgeon stammered that he hadn’t meant her face wasn’t worth operating on, but simply that surgery was unlikely to offer a substantial benefit.

My somewhat mollified grandmother collapsed back into her bed, but I’ve often thought since about the way the health system — and indeed all of us at times — tends to infantilise the elderly.

Not talking to somebody directly, assuming they won’t be able to grasp complex subjects, granting them less autonomy in decision making than a younger person — we’ve probably all been guilty of denying an old person fully adult status at some point.

Melbourne researchers raised some of these issues recently in a paper that sparked headlines around the world, thanks to its linking of two concepts we tend to prefer not to mention in the same sentence: old age and sexuality.

The fundamental human right to sexual expression is often denied to residents of aged care facilities, argue the authors from the Australian Centre for Evidence Based Aged Care.

Sexuality tends to be ignored or poorly addressed in institutional policies, and many facilities struggle to address the complex moral and ethical issues that can arise, they say.

“Particularly when a resident has dementia, staff apprehensions about the abrogation of their duty of care and concerns about unlawful activity, anxiety about potential risks to the resident, and fear of negative repercussions from a resident’s family make many facility managers wary of physically intimate activity among residents”, they write.

But should dementia automatically raise concerns about an individual’s capacity to engage in a sexual relationship? These authors think not.

They argue the onus should be on concerned staff to prove a resident is not capable of making decisions in this area, rather than on the individual to demonstrate they do have that capacity.

“While every effort should be made to ensure that no resident is at risk of being forced to participate in unwanted sexual behaviour, contracting a sexually transmitted disease or otherwise being harmed, this protection should not descend into paternalism”, they write.

Provision of condoms and discussion of sexuality during routine health checks could help to address the more practical risks, they suggest.

And, as for the emotional pain that might result from an unsuccessful relationship … well, that’s just part of being human. It’s certainly not something we as a society should seek to protect any adult from.

The federal Charter of Rights and Responsibilities for aged care residents does not specifically address sexuality, but it does declare a right to “select and maintain social and personal relationships with any other person without fear, criticism or restriction”.

Crucially, it also calls for recognition of a resident’s personal responsibility for their actions “even though some actions may involve an element of risk which the resident has a right to accept”.

It would be good to see the charter explicitly acknowledge residents’ right to continue or start a consensual intimate relationship, just as it currently protects their right to religious and cultural expression.

There’s no doubt this would pose a challenge in many aged care facilities: the authors of the current paper acknowledge staff can find supporting residents’ sexual needs “inconvenient, unpleasant or logistically challenging”.

But we need a fundamental rethink in this area. Like any other adult, aged care residents are entitled to reasonable levels of privacy, a double bed if they want one, and easy access to condoms, STD testing and other sexual health services.

It’ll be interesting to see what happens as the baby boomers start to enter residential care. The “make love, not war” generation is hardly likely to accept being reduced to a sexless existence in old age.

And, really, why should they?

Jane McCredie is a Sydney-based science and medicine writer.

Posted 9 July 2012