Department of Psychiatry, McLean Hospital, Belmont, Massachusetts. Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
Gerontologist. 2015 Oct;55(5):716-23. doi: 10.1093/geront/gnv098. Epub 2015 Aug 27.
Sexual expression can be an important aspect of well being for older adults with dementia living in nursing homes. There is a tension in the nursing home, however, between ensuring autonomy of residents for sexual expression and protecting residents from harm. To alleviate this tension, nursing homes can conduct an assessment of residents' capacity for sexual consent. This article argues that although such assessments can be useful in the initial evaluation of capacity, this is a somewhat flawed approach to sexual decision making and a finding of incapacity should not necessarily preclude sexual expression. In instances where residents are found to lack capacity but continue to express interest in sexual expression, a committee approach can be utilized where residents, the nursing home, and family members can convene to advocate for residents' autonomy, dignity, and right to sexual expression while working to minimize harm. Such advocacy decisions can be based on substituted judgment, a best interest standard, or some combination of the two. Although committee decision making for sexual expression seems intrusive, it at least allows for continued discussion of the right to sexual freedom for residents in the face of significant counterbalancing forces.
性行为表达对于居住在养老院中的老年痴呆症患者的幸福感而言是一个重要的方面。然而，在养老院中，既要确保居民在性行为表达方面的自主权，又要保护居民免受伤害，这两者之间存在一定的紧张关系。为了缓解这种紧张关系，养老院可以对居民的性同意能力进行评估。本文认为，尽管此类评估在能力的初步评估中可能有用，但这是一种对性行为决策有一定缺陷的方法，并且能力不足的结论不一定会排除性行为表达。在发现居民缺乏能力但仍表示有兴趣进行性行为表达的情况下，可以采用委员会方法，让居民、养老院和家属可以聚集在一起，倡导居民的自主权、尊严和表达性行为的权利，同时努力将伤害降到最低。这种倡导决策可以基于替代性判断、最佳利益标准或两者的某种组合。尽管委员会对性行为表达的决策似乎具有侵入性，但它至少允许在面对重大制衡力量的情况下，继续讨论居民的性自由权利。
