Final project report, 19 November 2020

This report is intended as a summary of the three-year Royal Society Marsden Fund-funded project “What counts as consent: Sexuality and ethical deliberation in residential aged care” (MAU-1723). The project was funded for the period March 2018 to February 2021. The aim of the project is to interrogate and inform conceptualisations of consent in the domain of sexuality and intimacy in residential aged care. The project completed and exceeded all recruitment and participation goals. While there is a general consensus that sexuality is an intrinsic part of human identity, intimacy and sexuality in aged care remain misunderstood and contested issues. This is particularly so in respect of older persons living with dementia. Gender and sexually diverse communities constitute a significant invisible and invisibilised minority in residential aged care (RAC), and that invisibility means their intimacy needs remain largely unknown and unacknowledged. There are cultural issues in aged care unique to New Zealand: for instance, while 85 percent of residential aged care facility (RACF) residents identify as European and an estimated 5.5 percent are Mäori, 44 percent of staff identify as other than European, including 10 percent who identify as Mäori, and 10 percent Pasifika. The dominant position in the theoretical literature on the ethics of sex and intimacy is that consent is of fundamental importance. Consent has dominated not just the theoretical discourse but also public and legal discourses about the ethics of sex and therefore carers and staff make decisions based on the management of institutional risk rather than the wellbeing of the resident. Vulnerabilisation of older persons in order to protect them, however well-intended, effectively robs them of possibilities to exercise self-governance, depersonalises them, and increases their social isolation. How sexual consent in particular is conceptualised has significant ethical implications for the growing number of elders in Aotearoa New Zealand who are living with degrees of cognitive decline. The specific contribution of this project is to interpret how aged care stakeholders (residents, families, and staff) make sense of consent, to contribute substantively to ethical theory around consent, sexuality, and intimacy, and to inform practice and policy in aged care environments. The project interrogates and intends to inform conceptualisations of consent in the domain of sexuality and intimacy in residential aged care. Our goals were: (1) to analyse how people are making decisions in practice about sex and intimacy in aged care; and (2) to use this information to inform the literature on ethical theory and discourses on consent and wellbeing. (From the Executive summary). Record #6913