JMIR Publications

ABSTRACT

Background:

This review focused on how sexual consent ability was determined, managed and enhanced in people with cognitive disabilities, with the added aim to better understand the recurring themes influencing how these approaches were designed and implemented. If a person’s consensual ability becomes compromised, due to either an early or late-onset cognitive disability, the legal, clinical or ethical systems involved must establish plans to balance the individual’s rights and restrictions to sexual expression. This review identified these plans, with a focus on how the approaches may promote the intimacy rights of the individual.

Objective:

(O1) Identify the approaches that determined sexual consent ability in people with cognitive disabilities. (O2) Identify the means of managing and enhancing sexual consent ability in people with cognitive disabilities. (O3) Note the recurring themes affecting how such approaches and management systems are designed and implemented.

Methods:

A systematic literature review was undertaken with searches of EBSCOhost (Social Gerontology, CINAHL Plus, MEDLINE, SocINDEX), Embase, PsyInfo and Scopus to locate reports on terms expanded on sexual consent and cognitive disability.

Results:

45 articles were identified, featuring assessment practices, legal case studies and clinical standards for managing sexual consent capacity in people with cognitive disabilities. There were 8 studies (n=5 qualitative, n=3 quantitative) out of the 45 articles. Approaches for determining sexual consent ability included Functional Capacity, Person-centered and Integrated concepts. Management of sexual consent ability included concepts involving Education, Attitude and Advanced Directives. Recurring themes that influenced these approaches included the 3 Legal Criteria of Consent, American Bar Association and American Psychological Association Model, Lichtenberg and Strzepek Instrument, Ames and Samowitz Instrument, Lyden Approach, Mental Capacity Act of 2005 and guides from sources such as the Vancouver Coastal Health Authority of 2009.

Conclusions:

The determination of sexual consent requires a holistic approach, with individuals being considered in terms of their adaptive abilities, capacities and human rights. The attitudes of those involved in this holistic approach will need to be balanced; otherwise, the sexual rights of such assessed people could be moved either in favor or against them. These approaches may reach the ideal outcome where person-centered considerations of those living with cognitive disabilities are understood and they themselves are involved in the process to personalize the approaches used to facilitate healthy intimate relationships.