There are events in life that do not fit our black and white moral principles. The monochromatic reality of our moral world is always outshone by the Technicolour nature of reality. People who are suffering from dementia expose some of these layers of moral predicaments.

In 2007 a story evolved involving a husband and wife, Donna Lou Young, a dementia patient living in a nursing home, and her husband Henry V. Rayhons, in Duncan, Iowa, US. Henry was assumed to have continued to have sex with his wife Donna while she was in the nursing home.

A week after Donna’s death at the age of nearly 79, Henry was charged with raping her. As with rape charges, there are tests and public exposure of behaviours that were intended to remain behind closed doors in the bedroom. Henry was eventually found not guilty, but the emotional damage diminished his dignity and his humanity as a husband. This case raises questions about who you are when you are diagnosed with dementia and, more importantly, what the law allows you to do, or allow others to do with you.

Dementia can shield as well as expose you to the imperfections of the law

That same week there was the case of a former British MP and lord against whom there was enough evidence of child abuse but who was not brought to court because he had dementia. The late (Lord) Greville Janner was alleged to have been a very active paedophile who committed 22 sex offences of indecent assaults and buggery between 1969 and 1988, involving nine children in State-run children’s homes. Despite the fact that he remained an active member and attended meetings of the House of Lords, the director of public prose­cutions, Alison Saunders, found it “against the interest of the country” to prosecute a likely paedophile because he was suffering from dementia.

Dementia can shield as well as expose you to the imperfections of the law. In a nursing home at Windmill Manor in Coralville, Iowa (again), two patients, both living with dementia, became lovers. Although everyone saw that this arrangement benefitted both of them, the husband of the female patient complained to the staff and it resulted not only in the couple becoming separated (a few months later the woman died) but the managers at the nursing home ended up losing their job.

In contrast, when there is an acceptance that dementia is a disease that erodes your me­mory and who you are, there can be acceptance of such physical foibles. The late Supreme Court Justice Sandra Day O’Connor shared her experience when her husband, who was living with dementia, was in a nursing home and he started a relationship with another resident.

Her acceptance of her husband’s affair with the female resident is Technicolour reality. A situation that has been immortalised in Alice Munro’s 1999 short story The Bear Came Over The Mountain. Sometimes there is an appreciation that for those living with dementia, sex might be one form of communication remaining among many dead forms of expression .

If we appreciate and understand this, how far will we go to satisfy the needs of a person living with dementia? Religion often has rigid moral judgements but when it is your loved one, how would you support their needs?

The Australian case of a daughter of a dementia nursing home resident who procures a sex worker for her father with the blessing of the nursing home staff might seem extremely liberal, but what if the nursing home was one of many run by religious organisations, as is the case in Malta?

These are easy moral decisions but they are not easy practical decisions to make. Sex rarely fits neatly into moral guidelines. Sadly, there are negative consequences. Older adults hiding their homosexuality when they enter an assisted living facility or a nursing home, because they might be mistreated if they came out as gay. Or the case of an (ostensibly) hetero­sexual resident who suddenly (to the caregivers) develops an interest in same-sex residents. What if the other person was not a resident but a caregiver? 

While not ignoring the sexual abuse of people living with dementia by caregivers, there are many instances where sex be­comes too morally complicated for us to make allowances. There is also another side. Some women report having sex with their husband living with dementia in order to calm him down when he is agitated. But sex without passion or emotional connection can leave the caregiver feeling degraded. Other people, especially with prefrontal dementia, become hypersexual. We can medicate to suppress these desires or allow these desires to be realised in a safe environment.

The law has always meddled with sex, and it has made many mistakes. Sex with dementia would prove to be a tricky moral and legal issue. The certainty is that the Technicolour of the reality of sex among those diagnosed with dementia will continue to confound us and to make us relinquish our monochromatic morals for a less rigid one with many hues.

Mario Garrett was born in Malta and is currently a professor of gerontology at San Diego State University in California, US.

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