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Valar Qringaomis

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Friday, July 29, 2016

Sex rights for the disabled?

"The public discourse surrounding sex and severe disability over the past 40 years has largely focused on protecting vulnerable populations from abuse... far less attention has been devoted to the intimacy needs of the mentally impaired and inhabitants of institutions... As the ideals of competence and consent. came to dominate medical ethics in the 1970s, the sexual desires of persons of limited capacity raised vexing and often unpalatable questions. An easy solution was to view sex as off-limits for those with impaired IQs. However, an English mother's 3-year-long crusade has finally shattered this taboo. Lucy Baxter’s international campaign on behalf of her adopted son, Otto, has also made clear that the sexual needs of the severely disabled require specific exemptions from certain general ethical and legal principles...

Sexual liberty has increasingly come to be regarded as a basic human right. As the organisation Health, Empowerment, Rights and Accountability has written:

Sexual rights are a fundamental element of human rights. They encompass the right to experience a pleasurable sexuality, which is essential in and of itself and, at the same time, is a fundamental vehicle of communication and love between people. Sexual rights include the right to liberty and autonomy in the responsible exercise of sexuality

... Denying an individual the right to pursue sexual contact or even intercourse with his fellow human beings would not be excusable on the grounds that this individual might achieve comparable pleasure through self- stimulation, because social scientists and sexologists have long recognised that the pleasure achieved through two-party sexual contact is both greater than and distinct from that achieved through masturbation. As moral philosopher Eugene Schlossberger has persuasively written;

Studies of human sexuality show that manual stimulation of the genitals is generally a more effective method of producing the appropriate physical sensations than is intercourse (since manual stimulation allows for greater control). Thus, were those who desire sex primarily seeking the appropriate physical stimulations, manual stimulation would be preferable to intercourse. Thus the fact that most people prefer intercourse to masturbation shows that most people's sexual desires are value-laden. In short, even those who frequent prostitutes are generally more interested in the psychological aspects of sex than the purely physical ones....

Many individuals have physical limitations such as cerebral palsy and spinal cord injuries so extreme that self-stimulation is not possible. However, even for individuals who are physically capable of masturbation, the act of physical contact with another human being appears to provide a degree of pleasure and fulfilment entirely distinct from mere masturbation, even when that contact lacks emotional intimacy and is the product of a commercial transaction. Psychologists have long recognised this phenomenon, although they have never adequately explained the causes. What is clear is that millions of individuals do employ the services of prostitutes each year, choosing to spent (sic) limited financial resources on a form of pleasure not available through masturbation. If any right to sexual pleasure does exist—- and this paper is grounded on that premise-—then it must be a right to mutual contact, not merely self-stimulation...

If sexual pleasure is a fundamental right, as this author believes, then jurisdictions that prohibit prostitution should carve out narrow exceptions for individuals whose physical or mental disabilities make sexual relationships with non- compensated adults either impossible or highly unlikely...

A second area in which reform is desperately needed is the ‘no sex‘ policies that exist in American nursing facilities, mental hospitals and group homes. Many such facilities require the doors of patients‘ rooms to be open at all times, making intimacy all but impossible. The assumption underlying these restrictions is that anything short of clearly expressed wishes by a fully competent and rational individual does not fulfil a minimum standard to consent to sexual relations The principle advanced by this approach is that institutionalised individuals require a higher degree of protection than those living outside of institutions. In many matters, this is certainly the case. However, in regard to sexual relations, this ‘higher standard' often serves as an obstacle to meeting both the wishes and interests of individuals who cannot conform to ‘real world' standards of consent

l believe a far more fluid standard is called for in cases of long-term institutionalisation. Sexual relationships between institutionalised individuals ought to be encouraged, as are other forms of social relationships, to the degree that they are mutually rewarding to both partners... For example, a married couple in which one partner has descended into dementia might still take both pleasure and meaning from sexual intercourse. even if one partner cannot overtly consent in the manner that would be expected of a person without dementia...

To err too far on the side of caution, preventing all sexual pleasure and intimacy in the name of protecting the vulnerable, is itself a cruel violation of a patient's basic rights...

If we are going to have a national debate in the USA surrounding the definition of health care, we should seriously consider including sexual surrogacy. For the disabled in the basket of services that we provide. Already, we have made the choice to pay for other purely social and cosmetic services to help unfortunate individuals lead more pleasurable and productive lives—such as breast reconstruction for mastectomy patients and plastic surgery for children born with cleft lips... Sexual pleasure ought not be viewed any differently. Most western healthcare systems acknowledge this, to some degree, paying for medications to treat erectile dysfunction in men and subsidising birth control pills for women. Some American states even fund abortion services and assisted suicide. Any notion of healthcare broad enough to encompass cosmetic surgery ought to be generous enough to include funding for the sexual pleasure of the disabled"

--- Sex rights for the disabled? / Jacob M Appel in J Med Ethics
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