CF: Have you decided where you draw the line at too incapacitated to give consent when someone is suffering from dementia?
It’s difficult to figure out exactly where the line is. My mother has moderate Alzheimers. She is scatty and has poor short-term memory, but can still have a conversation. Mr. Fang and I agree that if one of us were at her level of functioning we’d be fine with sex; we think someone at her level could consent.
My aunt, my mother’s sister, died of Alzheimers. Toward the end she was in a state where it was clear to all observers that consent or acceptance of sex would be out of the question. She was lying in bed moaning incoherently.
Somewhere between the two levels of functioning is the line. And I think for the Alzheimers patient and their spouse, there comes a time that actual sex is out, but other kinds of physical intimacy like snuggling, kissing and touching are still welcome for the affected spouse.
This has been a lot for your family to go through and I can see why you and Mr. Fang have discussed the issue. Thank you for that post. It is very useful to me in understanding the situation.
ETA: I have been waiting to see if anyone would bring up physical intimacy that doesn’t necessarily include sex. That seems to me something at least some individuals welcome, even when they are in pain at end of life. It has been seemingly very important and comforting to some of my elderly loved ones at the end.
Maybe I’m misreading, but it seems to me that according to the reports, the wife knew her husband and sought his company until the last visit before she died, which was after the incident. That tells me that she could have derived comfort from his physical presence even at that point. A person with dementia can enjoy a favorite food or song just on their own sensual merits, so why not intimacy with a spouse she still recognizes?
I think one problem is that whether or not you can consent to sex doesn’t depend on whether you can remember 3 simple words and repeat them for a tester or whether you know what year it is.
In this case, the wife allegedly pointed to her crotch and said “Henry likes this a lot.” Now, you may disagree with me, but I think that exhibits some degree of awareness of what was happening to her–if it actually was. It also indicates that she was aware that the sex was with her H and she recognized him.
The articles also say that the wife got upset when she was moved out of her single room and told the daughter that arranged it that the daughter was doing it just because the daughter didn’t like Henry. I don’t see this as something someone completely gaga would say. Again, I think it shows a lot of understanding of what was going on.
In any event, I don’t think this decision should have been made by one physician with the input of the daughters and without that of the husband. Most importantly, I think the wife should have been asked things like “Do you want us to tell Henry you don’t want him to touch you there any more?” or something along those lines. And I’d make sure she was asked the same question on different days at different times. Neither the Ds nor H should have been present when she was asked.
Remember, the only evidence there was sex was (1) the husband’s alleged confession and (2) the words of her 85 year old roommate who later recanted and said she heard a lot of whispering the second time around but really couldn’t say for sure it was sex.
I also think the criticism directed at the daughters is misguided. As this trial unfolds more facts come out.
It actually was not the daughters who called the police. It was the staff at Concord Care Center. Dr. Brady who made the determination that she no longer had the capacity to consent was actually the medical director at the facility and cared for Donna Rayhon. Once that determination was made the staff said they were under a legal obligation to notify the authorities if Mr. Rayhon did not abide by it. The staff insist the daughters had nothing to do with notifying the police.
I don’t have trouble with the idea of someone having sex with a spouse who is responsive, but has lost the verbal ability to articulate their feelings. But Alzheimers is progressive. At some point in the disease, the affected person is going get worse than that. They won’t understand who this person next to them is, or what is going on.
I interpreted some of the messages in this thread as saying that a healthy spouse should be able to have sex with their Alzheimer spouse at any point in the disease, no matter how advanced the Alzheimers is. In my opinion, at some point in the progression of Alzheimers, sex between the healthy spouse and the Alzheimers spouse stops being a healthy expression of marital love and starts being elder abuse. Figuring out where that point is, how children of affected people should behave, how spouses should behave, how care facilities should behave, all of that is difficult. But IMO, pretending that the sex is always all right at all stages of the disease avoids the problem by allowing abuse.
I admit I was surprised by the turn this discussion took, not just here but in other places. When I first heard about this case, I thought it was going to be a sad and difficult case that led us to consider and discuss where the line was between healthy sex and abuse for people with dementia. And I thought, that’s a difficult area but one that needs to be discussed. But instead I see a lot of people saying that there is no line, and the sex can never be abuse.
This may be another of those stories that helps us explore and understand our own prejudices.
I’m still struggling with the comparing end of life advanced directives forbidding heroic measures and an end of life directive permitting sex. It did occur to me the first withdraws consent, the second extends consent. But then there is the organ donation issue. It would never have occurred to me to make these comparisons at all. They seem very different to me.
I don’t know why someone wants the right to have sex with a partner who isn’t competent to consent at that point in time. I would like to trust spouses to do what is best for each other. But we all know that isn’t always a great idea.
@cardinalfang-
I for one would never, ever be of the school of thought that sex can never be abuse. My mother in law has severe dementia and basically has been out of it for a number of years, and there is no way I could consider sex with her consensual (to be honest, I am not even certain if I would consider some sort of living will, where let’s say the spouse says I consent to it even if I am out of it, consensual, though obviously that would be a different situation).
The whole “spouse has a right to sex” crap disturbs me to no end, the crap that religious conservatives are still pushing in this country (some of them are still trying, 40 years after the law changed, to have it that a spouse cannot be charged with raping the other person, that consent is implied when you are married), and if the woman was that far out of it I think there can be a case made…but it also hinges on what experts say. With all due respect to the director of the home,but what this case seems to be coming down to is the cops are charging the husband with rape based on the opinion of one person, and that bothers me.Unless the woman is totally out of it (and the fact that she died from Alzheimers doesn’t mean she necessarily was out of it, people can die from Alzheimer’s when they are still relatively lucid from what I have been read and told by the doctors treating my MIL).
I don’t have all the facts in this case, and it will come out in trial, but if the woman in question wasn’t totally out of it, and the charge of rape is coming down basically to the opinion on one doctor, I would be troubled (and perhaps there were other experts in the case who agreed she couldn’t consent, I didn’t see it there). It could be the husband was an arrogant jerk who decided to take advantage of his wife being comatose, and might deserve being charged with rape, but from what I have read this doesn’t seem cut and dried, and in a case like that, not sure justice will be served charging him with rape, if it is nebulous someone in the DA’s office and/or cops should have investigated further, if all they took was the word of the nursing home, and I realize that is a big if…
My mother scored a 5 on her cognitive ability test and I would say she is not competent to consent. She is the non-combative type of Alzheimer’s patient and will simply do whatever anyone tells her to do. She has no judgment whatsoever and cannot distinguish “friend from foe.” Donna Rayhon scored a zero on that test. A zero.
HarvestMoon1: I am so sorry you are dealing with this.
Is it possible for someone in your mother’s condition to indicate she wants sex? If so, does that happen often?
Do individuals with dementia experience lessened libido? Is there any norm there?
How do we best support their quality of life?
I read CF’s link to the Hebrew Home. It seemed an excellent and thoughtful exploration of the topic.
The daughter’s testimony and clarification on the state house attire issue:
This is where I have trouble with saying that if Mrs. Rayhons didn’t object then it must have been OK. What if she was compliant like HarvestMoon1’s mother, and would not object to being used for sex by any person? Surely we would not say that a person like that “consented” in any meaningful way, would we? Would we say she “consented” to sex with the janitor or the aide, too?
I don’t know whether Mrs. Rayhons’ doctor was justified in saying that she could no longer consent to sex. But I want an expert guardian to represent the Alzheimers spouse in cases like this. It’s all too easy for the healthy spouse who wants to have sex to deceive themselves about the cognitive state of their spouse.
@Consolation had asked about the daughters’ resistance to in-home care upthread:
@zoosermom, upthread, mentioned the idea that Henry Rayhons might be suffering some cognitive decline too. It looks like that might be a possibility.
The head of the care center also testified:
@ahl my mother has never brought up the issue, ever. My father is deceased so the Rayhons issue is not relevant here. But given that she is so compliant and lives on a floor where there are men, it is something that we keep on our radar. We ask the nurse whom we employ to do the same. My mother sits with some of the men at dinner but refers to them as her “brothers” and often calls them by the name of her now deceased brother.
We did have an incident where her nurse reported that my mother had lost her glasses. Two days later they did turn up and she reported they were found in another resident’s suite - that of a man. We immediately met with the Director of the facility who interviewed the aids. Apparently, one of the aids found them in the dining room and then inadvertently left them in the resident’s suite while attending to him.
I am not sure about the libido of Alzheimer’s patients except that I have seen no indication of one in my mother. She is very childlike. Honestly, having spent some time with the residents on her floor my perception is that the one thing ALL of them get most excited about is food.
I think the memory care unit where my mother lives does a wonderful job in supporting quality of life. They have an activities director that goes above and beyond and takes them to art museums, bakes with them every week and invites choral groups and pianists in to offer entertainment. Exercise classes are available for those who are able and every Friday is some sort of excursion to the local town where they have lunch and sometimes see a play at the university. They have a beautiful dining room where they are served their meals and food is pretty good. We supplement that with her nurse who also takes her out to have her hair and nails done, lunch or just a drive in the country. So quality of life can be maintained but I will say that it comes at great cost.
True, but as you said, it is progressive. My grandfather lived for years with us from the very start of the disease to an advanced stage. By the time he was moved to a home I would agree that he would not be able to consent.
After a few years he didn’t know who his grandkids were, but knew his kids. At that point there is no doubt in my mind that if my grandmother had been alive that he would have wanted to be intimate. A year or so later he didn’t know who his kids were but was still in great shape physically and had some parts of his memory that were unaffected. For example, he could still pick up an instrument and play a complicated piece of music from memory. He talked about his loving wife and how he missed her but couldn’t remember her name. Again, if she was around I would have had no qualms about him wanting to be intimate, even though at that point he didn’t remember a lot.
I agree, completely. I never intended my comments to indicate what you indicate in the first sentence of this paragraph. But, if I am in good shape physically and simply can’t remember much, then I have no problem with thinking that it is ok. I agree with your earlier comment about the “line” being somewhere between the two extremes that you listed. I don’t think in actual practice that our views are much different.
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I admit I was surprised by the turn this discussion took, not just here but in other places. When I first heard about this case, I thought it was going to be a sad and difficult case that led us to consider and discuss where the line was between healthy sex and abuse for people with dementia. And I thought, that’s a difficult area but one that needs to be discussed. But instead I see a lot of people saying that there is no line, and the sex can never be abuse.
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I don’t see what you see. I think we have been considering and discussing where the line is. I don’t think anybody has said there is no line. In my opinion you are reading too much into some of the statements. I think I have been as much on the one end of the spectrum as anyone and, like I said, I do not think that there is no line.
I will try to put it another way. Your coma example would be gross and I certainly would never condone that. However, let’s say I hit my head and am perfectly fine in every respect except that I have temporary amnesia. If my wife seduces me, it should not be rape just because I have no memory at the time of who she is.
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Mom2, is there any level of dementia at all where you would agree that a person is too out of it to have sex?
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Sure, someone who is unresponsive. In that case, it would be like having sex with a blow up doll or corpse.
The question i have is, What kind of responses was this woman having when her H visited? Did she smile? Did she talk? Did she hug? Did she kiss? or was she like a comatose vegetable?
Rape vs Sex in marriage is harder to define, no matter what the laws claim. If I wake up and my H has his hands on a sexual part of my body, is that rape or sexual assault or some crime just because I didn’t give some kind of consent first? lol …uh no, otherwise 90% of married men are rapists. What married woman hasn’t woken up to feel her H’s hands on her fanny, breasts or someplace else?
Adding to above…
Obviously, if I woke up and some stranger had his hands on me, that would be assault.
And, obviously, if I woke up and told my H to get his hands off of me, and he didn’t, that could be assault.
But, there are more gray areas within marriage.