Respect for intimacy among persons whose privacy is compromised

Respect for intimacy among persons whose privacy is compromised

Hashmi, SS, Jennifer Chandler , Fedoroff JP

(2018) Journal of the American Academy of Psychiatry and the Law 46(3):295-297



This invited commentary addresses an article by Joy and Weiss and their views on the potential use of sexual advanced directives“ a theoretical mechanism to assert sexual desire past in capacity....”Their article focuses on the importance of the sexual rights of individuals with neurocognitive disorders, principally dementia, in which there is a progressive decrease in executive functioning leading to impaired communication, understanding, and judgment. Individuals with dementia may be increasingly challenged to maintain autonomy in life, such as in cases of financial decision-making, self-care, end-of-life care, and, as Joy and Weiss point out, decisions pertaining to sexual relations. They highlight a possible trend of placing increasing restrictions on the freedom of aging patients to have sexual intimacy, to ensure their safety, and to prevent the potential of sexual abuse or other forms of harm. They propose the development of a “hypothetical sexual advance directive” for those at risk for incapacity, in collaboration with forensic psychiatrists. Although we agree that sexual rights should be legally protected by the established principles of the right to govern one’s own body, rights of privacy, and autonomy, we are concerned that the requirement to have a signed and witnessed sexual advance directive may have unintended consequences that decrease, rather than enhance the sexual rights of people with dementia and other types of intellectual disabilities. We propose an alternative in which established and consensual sexual intimacy is treated as an aspect of the right to bodily self-determination that should not require an advance directive.

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About the Author:

Jennifer A. Chandler researches and writes about the legal and ethical aspects of biomedical science and technology, with focuses on mental health law and policy, neuroethics, organ donation and regenerative medicine.  She is internationally recognized for her research and writing in the law and ethics of the brain sciences. She is an elected member of the Board of Directors of the International Neuroethics Society, and serves on international editorial boards in the field, including Clinical Neuroethics (part of the Cambridge Quarterly of Healthcare Ethics), the Springer Book Series Advances in Neuroethics, and the Palgrave-MacMillan Book Series Law, Neuroscience and Human Behavior. She is also a member of the international advisory boards for the Institut du Cerveau et de la Moelle Épinière (ICM) Neuroethics Network (Paris), and the Société française de psychologie juridique (Paris).

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