Who has the right to decide whether an Alzheimer’s patient may have sex? The patient’s children? The institution?

That is one of the many questions raised by an article in the NYTimes (Tuesday, April 14, 2015) in which reporter, Pam Belluck, reports on a case that is before the courts in Iowa.

78-year-old Henry Rayhons is charged with third degree felony sexual abuse of his wife, who was, at the time, in a nursing home, diagnosed with Alzheimer’s Disease. He has admitted to pulling the curtain around her bed, and having sex with his wife.

Ms Belluck writes that “it is widely agreed that the Rayhons had a loving, affectionate relationship.” He visited his wife twice a day. Although she could not remember her daughters’ names, or in cognitive tests, recall certain words, a staff member says she was always pleased to see her husband.

Mrs. Rayon’s daughter objected to the sexual relations and the nursing home staff agreed on the grounds that Mrs. Rahyons was not capable of consenting to sex.

So many aspects of this story trouble me. First, this was not a case of a man having sex with an Alzheimer’s patient. This was a husband and wife making love.

Married couples do not ask each other if they “consent” to sex, or try to determine first if the partner still knows what sex is. They ask each other in more loving ways – a touch, a stroke, a whisper in the ear. Some of the most intimate things are unsaid.

Ms Belluck writes that there was no sign of resistance or abuse. That would rule out marital rape. I presume the patient was not tied down or restrained. As it was a double room, and the other patient reported hearing signs of sex, but not cracks of whips or screams, it would not seem to have been violent sex. It was, after all, a hospital bed, not a Playboy playpen.

Was it consensual? Although an Alzheimer patient might not recall words, or faces, might not even be able to feed him or herself, he or she is capable of anger and they often exhibit great strength. My guess is that if Mrs. Rayhons didn’t want sex, she would have made it known by calling out or pushing her husband off the hospital bed.

I come at this story with a very personal point of view. I cared for my Alzheimer’s-diagnosed husband for seven years. I was able to keep him at home during that time. I gave up bathing him, reluctantly, only when it was clear I was not strong enough to do it safely. We shared our bed until two nights before he died when he was moved to a hospital bed, in our room. There was not a day during this time when we did not touch each other. If it had been necessary to put him in a nursing home, you can be sure, I would have pulled the curtain around the bed and climbed in beside him, as often as I could.

He had Alzheimer’s, but we were still married.

And even though he had Alzheimer’s, he was still human.

Long after the brain has forgotten many things, the body has a memory of its own. The irony here is that nursing homes know this. They have a list of things that are considered “inappropriate conduct” – one of them is masturbating in public places. If an Alzheimer patient can recognize the desire to pleasure him or herself why would anyone decide that a married couple would need the consent of their children or the institution before they can make love to each other  in the privacy of the patient’s room?

I suspect that some of the problem rests in the belief that we should outgrow the need for sex, that there is something unseemly about the elderly expressing love. The Hebrew Home at Riverdale in the Bronx is considered to be one of the finest nursing homes in the United States. Several years ago, it brought into affect a sexual rights policy based on the belief that aging does not mean a loss of sexual intimacy. Daniel Reingold, chief executive officer of the Home is quoted in the Times that family members can be very aggressive about opposing this policy.

Dear children: Please do take an active role in the care of your aging parents. Just please do remember that long after you have forgotten where you put your keys, you will remember what it feels like to make love, to be touched, to be embraced. The need for human contact continues as long as the heart beats.