Sexual Self-Determination of Individuals with Intellectual Disabilities—A Possible Philosophical Conceptualization and Resulting Practical Challenges

Abstract

(1) Background: Self-determination is one of the central values of many societies. Self-determination concerns many areas of life, including sexuality. Unfortunately, the sexuality of individuals with intellectual disabilities (IID) is often discriminated against, and even in their everyday care, sexuality is often given too little space, not least because of knowledge deficits of parents and staff. A practicable conceptualization of sexual self-determination is a prerequisite for helping IID to achieve self-determined sexuality. The aim of this paper is to formulate such an applicable conceptualization and to discuss related challenges. (2) Method: This paper uses Harry Frankfurt’s hierarchical conception of desires and the WHO definition of sexuality to develop a suitable understanding of sexual self-determination. (3) Results: The mentioned concepts offer promising tools to develop a conceptualization of sexual self-determination with high practical applicability. (4) Discussion: Sexual self-determination involves decision-making processes in relation to the different dimensions of sexuality. IID do need support to come to these decisions. Challenges that might be involved with such decision processes will be discussed.

Using Concept Mapping to Explore the Perspectives of People with Mild to Borderline Intellectual Disabilities Toward Sexual Health

“…People with mild to borderline ID who depend on their support staff and relatives for their sexuality-based support and education tend to integrate these negative attitudes from support staff and relatives with their own attitudes [ 14 , 52 ], which, in turn, potentially leads them to conclude that sexual behaviors are simply not for them. If support staff and relatives were to integrate a positive and holistic perspective on sexual health within their sexuality-based support and education, then it would allow people with mild to borderline ID to make more independent sexual decisions [ 53 – 55 ]. Several promising interventions are being developed [e.g., 56 , 57 ], although the transfer to daily life is still unclear [ 32 , 58 ].…”

What are the experiences of people with learning disabilities, and their support workers, when negotiating access to opportunities for developing relationships and intimacy?

“…This is also supported by the Mental Capacity Act (2005) and United Nations (2006) who provided legal frameworks to support and protect the rights of PWLD to safely access all areas of their lives. Necessary information and education should be available for PWLD to enhance their potential for self-determination and to make fully informed decisions (Skuban-Eiseler, 2022).…”