Injustice In Iowa: Pleasure, Danger, and Dementia

April 15, 2015

You know that I’m working on a book about sexuality, aging, illness, and dying, and that it’s a mother-daughter memoir, and so you know that issues about parents’ sexuality and the care that hospitals and nursing homes afford them are important to me. Yesterday morning as I read the paper and sipped my coffee I came across a story that broke my heart. It is the story of a 78-year-old man being tried for felony sexual assault because he allegedly had sex with is wife, a woman with dementia.

• Donna Lou Rayhons and Henry Rayhons were married in 2007 after each had been widowed. They would have been just about 70 when they married.
• In March of last year, Donna Lou Rayhons was placed in a nursing home after exhibiting symptoms of dementia. Henry reportedly visited every morning and evening.
• On May 15, some members of her family, including her husband, met with facility staff and discussed a new care plan that limited her ability to go out of the facility with her husband to Sunday church services.
• In response to her daughter’s concern that inappropriate sexual activity might be occurring, the facility social worker also asked the facility’s doctor to assess whether or not Donna Lou Rayhons was able to consent to sex. He said she was not able to consent.
• On May 23, she was moved from her private room to a shared room, and on that same day her roommate reported that she heard sexual sounds coming from Donna Lou’s side of the room after Henry came to visit and pulled the curtain that separated their beds. A security camera appears to show him depositing a pair of underpants in the laundry on his way out of the room later that evening.
• Staff members commented that Donna always seemed pleased to see Henry, and that no signs of physical or mental abuse were ever noted.
• Henry, when interviewed by an investigator, claimed that he and his wife did have sex sometimes, that she “enjoyed and occasionally asked for sex,” though he also said he didn’t remember their having sex on that particular night.
• After the May 23 incident, Donna Lou Rayhons was moved to a facility with a special dementia unit. Her daughter limited Henry’s visits.
• Donna Lou Rayhons died in August, three months later. Shortly after her death, Henry Rayhons was arrested.
• On October 2015, the State of Iowa filed felony charges against Henry Rayhons, accusing him of 3rd degree sexual abuse.

Issues of sexuality in institutions like nursing homes are complex to begin with. Add mental impairment and family conflicts they get more complicated. Nothing I am about to write should be construed as oversimplifying complicated issues. Rather, in my comments on this specific prosecution, I want to add to the conversation about those complexities by suggesting specific ways of thinking about pleasure and danger for elderly people with memory or cognitive disorders.

First, for a moment, lets assume that Henry Rayhons is indeed guilty of felony sexual assault in this case. Let’s assume that he did have sex with his wife after her doctor declared that she was unable to consent. Provided that there really is no evidence of his wife’s ever seeming troubled by the sex, or ever being harmed by it — indeed, given some evidence that she enjoyed sex with her husband even in the nursing home — is justice served by prosecuting this man for a class C felony which is punishable by up to 10 years in prison and a fine of $1000-10,000? Is there not a better way to address this man’s crime if it turns out he is guilty?

Next, let’s talk about the complexities of desire, intimacy and consent among adults with dementia. Even a thoughtful sexual rights policy like the one at Hebrew Home in Riverdale NY cannot make individual decisions about whether or not a particular person with dementia is able to consent to sex. What they can do, though, is provide useful guidelines for assessing situations on a case-by-case basis. Questions like whether or not the individual enjoys sexual contact, observations of behavior and emotional status before and after sex has occurred, accounting for the nature of the relationship in question, and considering what the role of intimacy was in the person’s life before the onset of dementia are all important, and yet even taken together they can’t offer us a foolproof guide for determining when consent can be truly given.

So, last, I think we need to stop and take a few deep breaths and be willing to ask whether sexual contact that is desired in the moment is ever acceptable even if consent cannot be reliably or meaningfully given. I am thinking about my mother again, and toward the end of her life there were many days when I would have said she was absolutely unable to understand or sign a contract. I would never have let her, on those days, make a financial decision. But in those moments I’d certainly have respected her desire for food or her wish not to eat. And if her boyfriend had been present, and she’d demonstrated in any way that she desired sex with him, and he with her, I’d have stepped out of the room for certain.

Is it possible that in some relationships it is okay to risk nonconsensual sex if it seems to bring pleasure or happiness to the individual having it? I think it is not only possible but necessary, and yet the fear of a loved one coming to harm affects even we who are very open-minded about sexuality, aging, and illness. Julie Gillis, producer of Bedpost Confessions, blogged about losing her own mother to Alzheimer’s disease, and when I posted Belluck’s article to Facebook this morning Julie and others began a thoughtful conversation. One of the things Julie acknowledged was her own fear for her mother’s safety and her parallel desire for her mother to have intimacy:

Abuse of folks in nursing homes (and sexual abuse as well) happens, a lot. It would terrify me to think of my mother being hurt or sexually mistreated and I paid close attention. That being said, if she had a friend to cuddle with and hold hands with and love on and was capable of it, I would have loved that for her.

Alzheimer’s is a deeply wounding and heartbreaking process for both the person suffering from it and for family members. As a daughter it was emotionally exhausting and devastating. I can’t imagine how it would be losing a beloved spouse little by little.

Clearly Henry Rayhons wanted to maintain the intimacy he had shared with his wife. It is impossible to know for certain what Donna Lou Rayhons wanted. Given the details offered by Pam Belluck in her New York Times story, and those included in the charge filed by the State of Iowa, though, it seems unlikely that she’d have wanted her husband to face prison after her death. The question of his guilt under the law is one thing. The question of justice is another. And neither is the same as the question about how to best facilitate pleasure while mitigating danger for the most vulnerable adults.

Elderly residents of nursing homes, people grappling with serious illness, those who seem lost in conditions like Alzheimers disease – such individuals are deeply vulnerable to abuse and exploitation. They deserve our careful protection. They also deserve pleasure, intimacy, and physical contact. It may not ever be possible to prevent every nonconsensual sexual act, but we can certainly do our best to distinguish between the staff member who preys on vulnerable patients and the roommates who don’t recognize their own daughters but end up in bed together every night. We can do our best to discern whether a person is distressed by sexual attention or whether they derive pleasure from it. And we can work at mediating between family members who might be in conflict about the actions or desires of a loved on who is in the throes of dementia so that it is the resident/patient’s needs that are met before those of a daughter, a husband, a lover, or a caregiver.

One of the most heartbreaking parts of this story, for me, is the apparent conflict between a daughter who loves her mother, and the husband who also loves the daughter’s mother. I am left to wonder whether this mother and daughter had ever talked about the role of sexual intimacy in the mother’s first marriage, or in between her marriages, or in her second marriage. Such frank conversations between adult children and aging parents are central to protecting those aging parents’ sexual rights when they become residents of nursing homes. There can be no reliable justice without them.