William Paterson University, USA.
University of Arkansas for Medical Sciences, USA.
Nurs Ethics. 2019 Sep;26(6):1654-1664. doi: 10.1177/0969733018780527. Epub 2018 Jul 18.
Caregivers and administrators in long-term facilities have fragile moral work in caring for residents with dementia. Residents are susceptible to barriers and vulnerabilities associated with the most intimate aspects of their lives, including how they express themselves sexually. The conditions for sexual agency are directly affected by caregivers' perceptions and attitudes, as well as facility policies.
This article aims to clarify how to approach capacity determinations as it relates to sexual activity, propose how to theorize about patient autonomy in this context, and suggest some considerations for finding an ethically responsible and practically feasible way to respect the sexual rights of this population.
The focus is on residents with early to moderate dementia in states of daily dependency on professional caregivers. The article critically examines existing empirical research on sexuality among persons with dementia, caregivers' attitudes, and institutional roadblocks to enabling residents' sexuality. A relational lens and insights from disability studies are used in the philosophical analysis.
No research participants were part of this analysis.
This article offers a conceptual analysis and normative framework only.
The analysis highlights the delicate balance that capacity assessments for sexual activity have to strike; while caregivers should protect those who cannot give adequate consent, the denial of sexuality among residents can cause deep, long-ranging harms. Sexual agency features into an ongoing sense of self for many individuals with dementia, and the imposition of inappropriate standards and expectations for sexual autonomy can lead to unwarranted obstacles to sexual activity.
Recommendations include developing clear and inclusive institutional policies and practices of care, providing education for caregivers on how to discuss and document residents' sexual preferences over time, and taking advantage of ethics consultation services.
This analysis establishes the need for more research and discussion on this sensitive topic. Future research should investigate the specific responsibilities of caregivers in furthering the sexual interests of residents, how exactly to modify existing capacity instruments, and how best to support historically marginalized patients in their sexual identities.
长期护理机构的护理人员和管理人员在照顾痴呆症患者时面临着脆弱的道德困境。患者容易受到与他们生活中最私密方面相关的障碍和脆弱性的影响，包括他们的性行为表达。护理人员的看法和态度以及机构政策直接影响到性行为的代理能力。
本文旨在阐明如何处理与性行为相关的能力确定问题，提出如何在这种情况下对患者自主性进行理论化，并为寻找一种对这一人群的性权利既尊重又负责任且切实可行的方法提供一些考虑因素。
重点是处于对专业护理人员日常依赖状态的早期至中度痴呆症的居民。本文批判性地审查了关于痴呆症患者的性行为、护理人员态度以及机构障碍的现有实证研究，采用关系视角和残疾研究的见解进行哲学分析。
本分析没有研究参与者。
本文仅提供概念分析和规范框架。
分析强调了性行为能力评估必须达到的微妙平衡；虽然护理人员应该保护那些无法给予充分同意的人，但剥夺居民的性行为会造成深远且持久的伤害。对于许多痴呆症患者来说，性行为代理是自我意识的一部分，对性行为自主性施加不适当的标准和期望可能会导致不必要的性行为障碍。
建议包括制定明确和包容的机构政策和护理实践，为护理人员提供关于如何随时间讨论和记录居民的性偏好的教育，并利用伦理咨询服务。
本分析确立了对这一敏感话题进行更多研究和讨论的必要性。未来的研究应调查护理人员在促进居民性兴趣方面的具体责任，如何准确修改现有的能力工具，以及如何最好地支持历史上被边缘化的患者的性身份。
