The Sexual Consent and Patients with Major Neurocognitive Disorders

Sexual consent has become an increasingly challenging and controversial topic for on-call physicians and many other clinicians as they navigate issues specific to patients with major neurocognitive disorders (formerly dementia). One of the reasons that assessing decisional capacity to consent to sexual activity may be difficult is that there are a host of clinical, ethical, and legal considerations that arise and are difficult to contemplate concurrently. In this chapter, we group some of these topics together as they are relevant to clinicians working in various institutional settings (e.g., nursing homes, medical and psychiatric inpatient units). From a risk management perspective, on-call physicians should be familiar with the local policies pertaining to sexual behavior of patients. Hospitals and other healthcare organizations may want to consider developing or revisiting their policies to guide on-call physicians in handling issues around consenting to sexual activity for patients with impaired decision-making capacity.