• ethics
• sexuality/gender
• aged
• dementia
• quality/value of life/personhood

Determining whether and/or how to enable older persons with disabilities to engage in sex raises several ethical considerations. With the goal of enabling the sexual functioning of older adults with disabilities, Jecker argues that sex robots could be used as a helpful tool. In her article, ‘Nothing to be Ashamed of: Sex Robots for Older Adults with Disabilities’, Jecker acknowledges the importance of sexual functioning and the fact that ageist assumptions incorrectly classify older persons as asexual. Additionally, older adults may experience disabilities that negatively influence their sexual functioning, which is problematic since sex may be linked to the following capabilities: developing a meaningful life narrative; being healthy; experiencing bodily integrity; feeling and communicating emotions; affiliating with others and reflecting on and choosing a life plan.1 In accordance with Nussbaum’s capabilities approach,2 Jecker says that society has a duty to support these capabilities at a minimal threshold. And insofar as sexual functioning may be relevant to the capabilities for older adults with disabilities, then we need to respond accordingly. One way of achieving this aim is by providing access to sex robots. I agree that sex robots ought to be made available for older adults with disabilities. Nevertheless, the article inspires several areas for further exploration.

As Jecker rightfully mentions, older adults are often incorrectly labelled as non-sexual. For instance, in their analysis of older individuals’ views on sex and quality of life, Gott and Hinchliff say that ‘[s]tereotypes of an asexual old age remain pervasive, shaping not only popular images of older people, but also research and policy agendas.’3 In addition to this incorrect descriptive claim that older individuals are asexual, a normative claim also seems to exist, suggesting that they should be non-sexual even if they have sexual desires. Ultimately, older adults are judged by unique criteria regarding acceptable behaviours, where sexual acts are typically ignored or considered impermissible.

One of the reasons that older adults’ sexual capabilities are at risk is because they are more likely to experience cognitive impairments. I commend Jecker for recognising the need to offer people with cognitive impairments the opportunity for sexual activity. In reflecting on this important need, however, I would argue that even more benefits than Jecker acknowledges may exist, specifically when it comes to considering sex robots and persons with dementia, the majority of whom are older than 65. Persons with dementia are often regarded as incapable of consenting to sex because of certain symptoms associated with the disease. And insofar as consent is an important part of engaging in legally and ethically licit sex, then it may be the case that people with dementia are prevented from having their sexual needs met even if we recognise these needs as important. While some authors have suggested different ways to think about consent for older adults with dementia,4 5 sex robots would presumably allow people with dementia to fulfil their needs regardless of whether they can provide or understand consent.

One objection to providing sex robots to people with dementia is the idea that individuals should not have access to robots if they cannot fully appreciate what they are/are not doing. Jecker responds to this objection by highlighting the importance of sexual functioning, the harms that may result from not having sex, and introducing Mill’s harm principle as a way to mitigate potentially harmful consequences. In addition to Jecker’s response, it may also be the case that using tools such as sexual advance directives could help to determine whether sex with a robot is ethically licit. Although not currently legal, Alexander Boni-Saenz proposes that sexual advance directives could be used as a way for people with dementia to have their previously expressed sexual desires fulfilled, even if they are not capable of consenting to sex when they have dementia.4 Boni-Saenz’s approach is called the ‘consensus of consents’. The idea behind this approach is that sexual advance directives would give people the opportunity to outline their sexual preferences when they are capable, and then to pursue those preferences when they are incapable only insofar as they affirmatively express a desire to do so (ie, only if they are in consensus with their previous consent). So, if sex robots are an available option for older people with dementia, then perhaps individuals could be asked about whether and/or when they would want to use a sex robot in the future. If a capable person says that they would want to use a sex robot and subsequently expresses a desire to have sex with the robot (ie, when they have dementia and are incapable of consenting), then they would be seen as achieving a consensus of consents.

Although I do not think that people with dementia need to fully appreciate what they are/are not doing when it comes to sex robots, it may be important to understand the kinds of harms that could result from a person not being able to distinguish between humans and human-like robots. Jecker notes that one criticism of using sex robots is that it may endorse an extreme form of objectification—sex robots are primarily designed to look like young attractive women, which may bolster society’s propensity to objectify women for the purpose of serving heterosexual men. In response, Jecker says that we may want to broaden sex robots’ appeal. She also highlights that a person’s interaction with robots does not violate the rights of another human. While I agree with Jecker’s responses and think that objectification is not always necessarily harmful, it is typically thought that undue objectification is morally problematic. This makes me wonder whether a person with dementia may be likely to unduly objectify humans with whom they interact if they are permitted to objectify sex robots, specifically if they cannot distinguish between robots and humans. If so, then should we confirm whether people with dementia can distinguish between robots and humans before offering sex robots as an available option? This is an area that needs more scholarly attention. Jecker’s suggestion to use Mill’s harm principle provides some guidance, but then I wonder that if sex robots cause harm, then what alternatives may be available for this already vulnerable population (ie, people with dementia) when it comes to having their sexual needs met? Ultimately, the collision of emerging technologies with the dismantling of ageist assumptions is leading us to a landscape ripe for more academic attention; a landscape to which Jecker makes a very meaningful contribution.

In short, sex robots may serve as a beneficial tool to enable sexual functioning for older adults with disabilities. Specifically, I believe that this technology holds promise to overcome some of the hurdles that exist in relation to sex, dementia, and consent.