What counts as consent? : sexuality and ethical deliberation in residential aged care : final project report 19 November 2020
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Date
2020
DOI
Open Access Location
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Massey University
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Abstract
This report is intended as a summary of the three-year
Royal Society Marsden Fund-funded project “What
counts as consent: Sexuality and ethical deliberation
in residential aged care” (MAU-1723). The project was
funded for the period March 2018 to February 2021.
The aim of the project is to interrogate and inform
conceptualisations of consent in the domain of sexuality
and intimacy in residential aged care. The project
completed and exceeded all recruitment and participation
goals.
While there is a general consensus that sexuality is an
intrinsic part of human identity, intimacy and sexuality in
aged care remain misunderstood and contested issues.
This is particularly so in respect of older persons living
with dementia. Gender and sexually diverse communities
constitute a significant invisible and invisibilised minority
in residential aged care (RAC), and that invisibility
means their intimacy needs remain largely unknown and
unacknowledged. There are cultural issues in aged care
unique to New Zealand: for instance, while 85 percent
of residential aged care facility (RACF) residents identify
as European and an estimated 5.5 percent are Mäori, 44
percent of staff identify as other than European, including
10 percent who identify as Mäori, and 10 percent Pasifika.
The dominant position in the theoretical literature on
the ethics of sex and intimacy is that consent is of
fundamental importance. Consent has dominated not
just the theoretical discourse but also public and legal
discourses about the ethics of sex and therefore carers
and staff make decisions based on the management of
institutional risk rather than the wellbeing of the resident.
Vulnerabilisation of older persons in order to protect
them, however well-intended, effectively robs them of
possibilities to exercise self-governance, depersonalises
them, and increases their social isolation. How sexual
consent in particular is conceptualised has significant
ethical implications for the growing number of elders in
Aotearoa New Zealand who are living with degrees of
cognitive decline.
The specific contribution of this project is to interpret
how aged care stakeholders (residents, families, and
staff) make sense of consent, to contribute substantively
to ethical theory around consent, sexuality, and
intimacy, and to inform practice and policy in aged care
environments. The project interrogates and intends to
inform conceptualisations of consent in the domain of
sexuality and intimacy in residential aged care. Our goals
were: (1) to analyse how people are making decisions in
practice about sex and intimacy in aged care; and (2) to
use this information to inform the literature on ethical
theory and discourses on consent and wellbeing.
Description
A Royal Society Marsden Fund Project.
Keywords
Older people, Institutional care, Sexual behavior, Moral and ethical aspects, New Zealand