Ethical Issues in Distinguishing Sexual Activity from Sexual Maltreatment among Women with Dementia

A report from the National Center on Elder Abuse (NCEA) defines sexual abuse as nonconsensual sexual contact of any kind with an elderly person. While such forces as ageism, sexism, and hypercognitivism uniquely situate women with dementia as at risk for sexual maltreatment, autonomy-centered bioethical approaches may, like the NCEA, fail to differentiate between coercive and assentual forms of “nonconsensual” sexual activity. This critical analysis brings to light the complexity of sexual ethics in the context of cognitive impairment. The author argues, from a relationship-centered perspective, that although women with dementia are particularly vulnerable to abuse certainly some, if not most, sexual activity between loving spouses may be morally permissible even when one partner has dementia and cannot consent.