Old Age Psychiatry, Oxleas NHS Foundation Trust, Bromley, UK.
The Dickson Poon School of Law, King's College London, UK.
Gerontologist. 2021 Sep 13;61(7):1001-1007. doi: 10.1093/geront/gnaa139.
Some individuals develop dementia and the invariable consequence of dementia is a decline in cognition and level of functioning. Despite the effects of this illness, people with dementia still seek intimacy and companionship as part of their expression of basic human instincts and have the right to equal enjoyment of relationships and privacy for such. At the same time, they have the right to be safeguarded against abuse. The law in England and Wales, in common with the majority, if not all, jurisdictions around the world is clear on the requirement for contemporaneous consent to sexual activity, thereby creating unmet needs for people with dementia who no longer have the capacity to consent to intimacy/sexuality. This creates an impetus to find ways to empower individuals with dementia to enjoy intimacy in a safe and lawful way and enable them to live well despite dementia. This article proposes an instrument known as the Advance Decision on Intimacy, in pursuit of the concept of precedent autonomy, to empower individuals to make decisions about how they would wish to express their sexuality at a material time in future when they would have lost the capacity to consent to such acts. While the article is framed by reference to English law, the principles are of wider relevance.
一些人会发展为痴呆症，而痴呆症不可避免的后果是认知和功能水平下降。尽管这种疾病有影响，但痴呆症患者仍在寻求亲密关系和陪伴，这是他们表达基本人类本能的一部分，他们有权平等地享有这些关系和隐私。同时，他们有权免受虐待。英国和威尔士的法律与世界上大多数（如果不是全部）司法管辖区一样，明确要求对性活动进行同时代的同意，从而为那些不再有能力同意亲密关系/性行为的痴呆症患者创造了未满足的需求。这就需要寻找方法来赋予痴呆症患者以安全合法的方式享受亲密关系的能力，并使他们即使患有痴呆症也能生活得更好。本文提出了一种称为“亲密关系预先决定”的工具，以追求先例自治的概念，使个人能够在未来丧失同意此类行为的能力时，就他们希望如何表达自己的性行为做出决定。虽然本文是根据英国法律制定的，但这些原则具有更广泛的相关性。
