56-year-old male resident of your long-term care (LTC) home who is married with three children under age 18. He was formerly in the Canadian Armed Forces and served in Afghanistan. He has suffered from an intracranial aneurysm 2+ years ago, and due to his increasing care needs his wife had to place him in LTC. He has significant brain damage with frontal disinhibited behaviors including; sexual disinhibition, repetitive verbal outbursts, wandering. Because of this, he attempts masturbation frequently in public areas, and has just developed a still platonic relationship where he and a female resident hold hands. He also often seeks her out and has tried going into her room at night. Staff have expressed significant concerns.

What are some of the ethical issues in this case?

Should LTC homes respect this resident’s privacy?

How should LTC homes address sexual and intimacy needs of residents with dementia? Should they assist?

Does the LTC home, or do any staff, have an obligation to protect vulnerable residents such as this one?

After 7 years of caring for his wife with severe Alzheimer’s disease at home, Mrs. Dowd is admitted to a LTC home. Upon returning to visit his wife, Mr. Dowd finds her walking hand-in-hand with a male resident. Staff report Mrs. Dowd has been observed following this male resident into his room which is right next to her room. Mr. Dowd becomes angry and states, “Look, it is your job to protect my wife. Get that man out of here right now. I don’t want her involved with any other man. That’s why I admitted her here.”

*From: http://www.alz.org/documents/mndak/406Sexuality_in_Care_Setting_Case_Studies.pdf

What are some of the ethical issues in this case? What should we do?

Is Mrs. Dowd able to understand and appreciate her actions with the male resident?

Do the staff have an obligation to intervene to protect Mrs. Dowd? Or at the request of Mr. Dowd?

If Mrs. Dowd was capable (competent), would the responsibility of the LTC home staff remain the same?

Sam and Mr. Brown had been together for years. They had a strong social network of friends who provided support and friendship over the years. Unexpectedly, Mr. Brown suffered a debilitating stroke with resulting vascular dementia. After months of rehabilitation that did little to help, Mr. Sam was forced to move Mr. Brown in to a long-term care home.

Sam is unsure how the staff might treat Mr. Brown if they learn that he is homosexual, so he does not reveal their true relationship. He makes sure not to show too much affection when staff are present. Staff sense there is more to their relationship than just life-long friends and housemates. Staff begin to talk among themselves about Mr. Sam and Mr. Brown being gay, and some now feel uncomfortable caring for Mr. Brown because of their own personal values.

*From: http://www.alz.org/documents/mndak/406Sexuality_in_Care_Setting_Case_Studies.pdf

What are some of the ethical issues in this case?

Can the staff object to caring for Mr. Brown based on his sexual orientation? Is there a right to conscientious objection, or is this discrimination?

How far might the rights of Mr. Sam and Mr. Brown extend? If they required physical assistance to be intimate, for example, would staff be able to object?

What steps can the LTC home take to ensure Mr. Brown is treated fairly, and no differently because of his sexual orientation?