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Criminal charges against a loving spouse merely for continuing a sexual relationship they both enjoyed, and which seems beneficial, not harmful, to the patient, is quite another.{/INSERTKEYS}{/PARAGRAPH} Indeed, by all accounts, theirs was a loving and affectionate relationship, and Mrs. Rayhons was always pleased to see her husband. It comes up also in cases where patients initially resist food and water, but can be coaxed to eat. That outmoded idea should be discarded. Why would we want to diminish that? This is likely to be a greater concern with new relationships that spring up in the nursing home. Of course, this needs to be balanced against protecting patients, especially patients with severe dementia, from coercion and exploitation. Evidence of abuse or mistreatment is one thing. Using affirmative consent as the standard would deprive patients with severe dementia of sexual relationships, because few retain the capacity to articulate a desire for sex. For example, it is increasingly recognized that engaging in kissing or petting is not consent to sexual intercourse. Apparently, Mrs. We certainly do not want social workers or psychologists monitoring the sexual activity of residents! However, they can observe whether the resident is happy to see and be with the spouse, and whether she seems upset after visits. Without any signs of abuse, what was the basis for the arrest? Under common law, laws against rape were not considered applicable in marriage. {PARAGRAPH}{INSERTKEYS}Rayhons died in August. The case raises questions about the capacity to consent in cases of severe dementia, an issue that is not limited to sexual relations. That is, both partners must give affirmative consent, whether verbal or otherwise, for sex to be consensual. In other contexts, the absence of affirmative consent to sexual relations may be the right criterion for rape or other sexual abuse. By , it was a crime in all 50 states. This is not easy to determine, since sexual relations are by their nature private and intimate. However, this case is clearly not a case of spousal rape. Acknowledging sexual rights means giving patients the privacy to have sexual relationships. No one suggests that Mrs. Rayhons resisted sexual contact with her husband, nor were there any signs of abuse. He said she was not. That pleasure was undoubtedly less visible in the final stages of her dementia, but even then there were minimal signs that she enjoyed this contact, and none that she did not.