During the 20th century, society’s view on sexualities has undergone a severe paradigm shift. While moving away from ideas of decency and bawdiness to evaluate legitimate sexuality, concepts of autonomy and consent gained importance. This transformation is also challenging the law.1 With the broad acceptance of various forms of sexual behavior and sexual orientation, legal regulation based on morality and ethics is outdated. Recent debates on law and sexualities focus on sexual autonomy and its conditions. This is shown especially by the legal debate on sexual violence and criminal law.2 But the right to sexual autonomy does not only require adequate protection against sexual violence. As a human right, it obliges State Parties to Human Rights Treaties such as the European Convention on Human Rights and the Convention on the Elimination of Discrimination against Women to respect, protect, and fulfill sexual autonomy. This includes the guarantee of freedom from sexual violence, coercion and discrimination, as well as control over one’s own body and over the involvement in sexual interactions with others. In order to ensure the different components of sexual autonomy, sexual education and reliable access to information and medical services are necessary. This paper presents an approach concerning the multifaceted dimensions of sexual autonomy through a human rights lens.

Supporting sexual rights in residential long-term care is ethically complex. The well-being of care workers and residents is inextricably linked, and increasingly recognized empirically, yet public policy in Canada generally continues to exclusively focus on either the well-being of residents or workers. The consequences of this are particularly evident when we consider how to prevent sexual harassment towards workers without unjustly restricting the freedom of sexual expression for residents living with dementia. Employing Carol Bacchi’s “What’s the Problem Represented to be?” approach, we critically analysed a recent Canadian action plan to prevent sexual violence and harassment. Our analysis suggests that this policy is less than promising and may reproduce the very phenomenon it is intended to redress. The need to refocus prevention efforts on the structural factors implicated in this phenomenon is urgent if we are to support the sexual rights of both care workers and residents.

Clear policies regarding sexual expression, sexual behaviour and related decision-making assist in ensuring that the rights of people with mental disorder or intellectual disability are upheld, and that staff know how to react to situations consistently and lawfully without interfering on the basis of their own moral judgements or personal beliefs. Sensitive and holistic planning of care that complies with domestic law, international human rights law and statutory guidance is necessary to complement such policies. Non-intimate physical contact, masturbation, sexual relationships, contraception, sterilisation and vasectomy, pregnancy, termination of pregnancy, sexual dysfunction, parenthood, marriage and civil partnership, divorce, prostitution, pornography, and sex aids and toys are all matters that may properly be part of care planning.