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Criminal charges against a loving spouse merely for continuing a sexual relationship they both enjoyed, and which seems beneficial, not harmful, to the patient, is quite another.{/INSERTKEYS}{/PARAGRAPH} {PARAGRAPH}{INSERTKEYS}Rayhons died in August. Why would we want to diminish that? This is likely to be a greater concern with new relationships that spring up in the nursing home. That is, both partners must give affirmative consent, whether verbal or otherwise, for sex to be consensual. We certainly do not want social workers or psychologists monitoring the sexual activity of residents! Apparently, Mrs. He said she was not. Acknowledging sexual rights means giving patients the privacy to have sexual relationships. The case raises questions about the capacity to consent in cases of severe dementia, an issue that is not limited to sexual relations. In other contexts, the absence of affirmative consent to sexual relations may be the right criterion for rape or other sexual abuse. Evidence of abuse or mistreatment is one thing. That outmoded idea should be discarded. However, they can observe whether the resident is happy to see and be with the spouse, and whether she seems upset after visits. For example, it is increasingly recognized that engaging in kissing or petting is not consent to sexual intercourse. Rayhons was always pleased to see her husband. Rayhons resisted sexual contact with her husband, nor were there any signs of abuse. This is not easy to determine, since sexual relations are by their nature private and intimate. Without any signs of abuse, what was the basis for the arrest? Under common law, laws against rape were not considered applicable in marriage. By , it was a crime in all 50 states. Using affirmative consent as the standard would deprive patients with severe dementia of sexual relationships, because few retain the capacity to articulate a desire for sex. It comes up also in cases where patients initially resist food and water, but can be coaxed to eat. However, this case is clearly not a case of spousal rape. That pleasure was undoubtedly less visible in the final stages of her dementia, but even then there were minimal signs that she enjoyed this contact, and none that she did not. No one suggests that Mrs. Of course, this needs to be balanced against protecting patients, especially patients with severe dementia, from coercion and exploitation. Indeed, by all accounts, theirs was a loving and affectionate relationship, and Mrs.