Ethics in sexual behavior assessment and support for people with intellectual disability

Abstract

Sexuality is an issue of equality, rights, and ethics, especially when it comes to the sexuality of people with intellectual and developmental disabilities (IDD). This paper offers a discussion of ethics related to the assessment and intervention supports of sexual behavior in people with IDD. A brief history of sexuality and disability is presented. Issues of sexual abuse of people with IDD and the laws related to sterilization, pornography, sexual rights, and consent are explored. Finally, specific ethical concerns related to intervention by behavior analysts in the realm of sexual behavior are examined.

Evidences of an Implemented Training Program in Consensual and Responsible Sexual Relations for People with Intellectual Disabilities

“…While there is growing awareness of these rights, very limited progress has been made in supporting these individuals in creating and maintaining intimate and personal relationships [ 2 ]. Sexuality is a matter of equity, rights, and ethics, especially when it refers to the sexuality of people with intellectual and developmental disabilities [ 3 ].…”

Approaches to Determine and Manage Sexual Consent Abilities for People With Cognitive Disabilities: Systematic Review

“…A placeholder definition of consent requires that a person communicates a “knowing, intelligent, and voluntary agreement to engage in a given activity” [ 8 , 9 ]. Assessments that measure consensual ability for a sexual relationship are often based on a person being able to satisfy all three of the following criteria [ 3 , 7 , 10 , 11 ]:…”

“…Some experts argue that an individual’s sexual preference is a form of personal expression, not always systematic or organized, including the weighing of risks and benefits, unlike the 3 legal criteria of consent by the medical and judicial systems in the United States [ 10 , 19 ]. Consent capacity is considered a state instead of a trait, meaning it is expected to change over time [ 11 ], and it must be determined in the present moment: not a decision made ahead of time [ 22 ]. Assessments of a person’s ability to demonstrate capacity in 1 or all 3 prongs of consent can be determined by questionnaires such as the Mini-Mental Status Exam (MMSE) to determine rationality or the Tool for the Assessment of Levels of Knowledge Sexuality and Consent [ 11 ].…”

“…Consent capacity is considered a state instead of a trait, meaning it is expected to change over time [ 11 ], and it must be determined in the present moment: not a decision made ahead of time [ 22 ]. Assessments of a person’s ability to demonstrate capacity in 1 or all 3 prongs of consent can be determined by questionnaires such as the Mini-Mental Status Exam (MMSE) to determine rationality or the Tool for the Assessment of Levels of Knowledge Sexuality and Consent [ 11 ]. However, the use of these assessments is controversial because of the following:…”

“…Sexual abuse occurs when one person forcefully or covertly performs nonconsensual sexual acts, including touching, kissing, oral sex, and anal or vaginal intercourse [ 3 , 34 ]. Sexual abuse may also involve threatening, coercing, tricking, or manipulating another person into unwanted sexual contact or into such contact in which the other person does not have the capacity to consent [ 11 ]. According to the Criminal Code of Canada , an alleged case of sexual assault requires a juridical system to check if people take reasonable steps to ascertain consent [ 13 ].…”