As a society, we don’t like talking about dementia. It’s uncomfortable. But I can top that. Today we are going to talk about dementia and sex. Awkward.

Although I am not going to focus on the specific case and will reflect more on the larger issues at hand, a rape case involving an Iowa state lawmaker got me thinking. If you haven’t heard about the case, here is more info from the Des Moines Register:

http://www.desmoinesregister.com/story/news/crime-and-courts/2014/12/13/former-legislator-charged-raping-wife-dementia/20305991/

Here are the Cliff Notes….Henry Rayhons (who has served nine terms in the Iowa House of Representatives) and Donna Young, both in their 70’s, married in 2007. Donna began showing signs of dementia, was diagnosed with Alzheimer’s, and was eventually admitted to a nursing home. Henry visited frequently, and Donna’s daughters (from her first marriage) alleged that Rayhons often wanted to have sex once or even twice a day. Rayhons was presented with a physician-approved document stating that Donna was unable to consent to sex due to her dementia. He allegedly continued and was charged with rape stemming from a May 23, 2014, incident where he had intercourse with his wife. Donna passed away on August 8, 2014, due to complications of Alzheimer’s.

To be clear, I’ve followed this case closely in the press and have talked casually to a few people who are tangentially involved, but I don’t have any insider information and am not stating an opinion about the case.

I decided that I would discuss the issues involved in this case with my Families and Aging class a few months ago. I walked into the classroom with absolutely no idea how to approach the topic and an expectation of total awkwardness. I decided to attempt to make it seem relatable to them. So how do you make sex in Dementialand relatable to college students? Oy vey.

We talked about how the university inundates them with information about sexual consent. (I’m not saying that the university should not inundate them with this information, but the students in my class used this word several times.) They are required to take a quiz about sexual consent before they can register for classes. I haven’t seen the quiz, but I am assuming it doesn’t mention dementia. I am assuming it does mention alcohol consumption. We started there.

I asked my class, “Can someone consent to have sex if they’ve had one drink?” The vast majority nod their heads definitively. (Side note: Someone in my class points out that if you cannot consent to sex after having one drink, we’ve just made 90% of sexual encounters on college campuses sexual assault. It may be a fair point.)

Then I ask my class, “Can someone consent to sex if they have had 12 shots of tequila?” The vast majority say no.

Next I ask them how many drinks someone can have and still consent to sex. I tell them I need a number. Silence. We talk about how this is a gray area.

Then comes my challenge as an instructor–trying to show how this is relevant to sex in Dementialand.

Being diagnosed with dementia does not take away your ability to consent. Many people with dementia have active sex lives. However, I would argue that very few people in the end stages of dementia would be able to consent. Just like my students perceive a blurred line in ability to consent due to alcohol, there may be a blurred line in the ability to consent due to dementia.

I will argue that if a person cannot identify their potential sex partner or misidentifies them, they are not able to consent. I will argue that if they cannot comprehend their potential sex partner’s intentions, they are not able to consent. But this still leaves a murky gray area that makes me uncomfortable. And, from my admittedly limited research, state laws do not do much to minimize that murky gray area.

Although the Henry Rayhons case is an interesting one, there are other circumstances (beyond spousal relations) that warrant consideration. It is common for two individuals with dementia who share living space, such as in an assisted living, to spend time together and start relationships. These individuals may or may not be married to other people. When are they just two consenting adults, and when are they…well…not? How do we decide if and when sexual relationships between two people with dementia are okay? Are they ever okay?

I know I’ve presented quite a few questions here, but no answers.

One final note…As I was looking at online newspaper articles about the Henry Rayhons case, I was appalled at the comments readers had made on the internet regarding the situation. Some just showed an ignorance about dementia, and I can deal with that. However, many were disgusting, insensitive, and even inhumane.

If this had been a case where a man was charged with the rape of a child, I would guarantee that these types of comments would not be tolerated. Why is it so much harder for people to have empathy for those who live in Dementialand?