PhD | Philosophy 

Andria BianchiBy 2030, 75 million people will be diagnosed with dementia worldwide. Many of them will be sexually active. But how can they consent to sex?

It’s a question that Andria Bianchi is examining for her PhD dissertation in philosophy. Through her research, which included placements at two Toronto hospitals as part of the department’s new applied philosophy PhD program, Bianchi learned that many clinicians and caregivers are unsure how to handle the issue of consent for those with dementia, and are uncomfortable talking about it.

"I think it’s a taboo topic," says Bianchi. "It’s something that is not commonly spoken about day to day. Health care workers were more comfortable speaking about medical decisions and sometimes that was the only experience they had and had considered."

Bianchi also learned most institutions don’t have policies about sexual consent and sometimes police are brought in to investigate issues. In 2015, a 78-year-old retiree was found not guilty of sexual abuse after having sex with his wife in an Iowa nursing home. Staff believed she was no longer capable of consenting due to Alzheimer’s disease. Bianchi used the U.S. case to illustrate the challenge in her Three Minute Thesis presentation, for which she was awarded the runner-up prize at the university-level finals on March 23.

In an effort to enable people with dementia to have their own sex lives, Bianchi envisions three potential approaches to the problem. First, family and clinicians can make decisions based on the patient’s prior wishes and values. Although this might be beneficial in some circumstances, it can be problematic since dementia often changes a person, including their interests, says Bianchi. Sometimes, they forget their spouse.

The second option is, family members and clinicians can try to enable and support a patient, who may struggle to show consent in typical ways, to make their own autonomous decisions. “There are cases where this might not be the best approach, if family members and caregivers have their own values that could be forced onto the person with dementia.”

Finally, consent can be dismissed entirely in this population and family and clinicians can instead focus on individual happiness and pleasure.

Bianchi is uncomfortable with an approach that says people who can’t consent to sex in typical ways shouldn’t be having sex. She hopes her research will inform and influence changes at the institutional or even governmental level. At the very least, she hopes people will talk more about it.

Watch Andria Bianchi's Three Minute Thesis finalist video below.