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That is, both partners must give affirmative consent, whether verbal or otherwise, for sex to be consensual. However, this case is clearly not a case of spousal rape. Of course, this needs to be balanced against protecting patients, especially patients with severe dementia, from coercion and exploitation. We certainly do not want social workers or psychologists monitoring the sexual activity of residents! Why would we want to diminish that? No one suggests that Mrs. 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} It comes up also in cases where patients initially resist food and water, but can be coaxed to eat. In other contexts, the absence of affirmative consent to sexual relations may be the right criterion for rape or other sexual abuse. Rayhons resisted sexual contact with her husband, nor were there any signs of abuse. The case raises questions about the capacity to consent in cases of severe dementia, an issue that is not limited to sexual relations. For example, it is increasingly recognized that engaging in kissing or petting is not consent to sexual intercourse. {PARAGRAPH}{INSERTKEYS}Rayhons died in August. Indeed, by all accounts, theirs was a loving and affectionate relationship, and Mrs. By , it was a crime in all 50 states. That outmoded idea should be discarded. Without any signs of abuse, what was the basis for the arrest? Rayhons was always pleased to see her husband. Apparently, Mrs. This is likely to be a greater concern with new relationships that spring up in the nursing home. Under common law, laws against rape were not considered applicable in marriage. He said she was not. This is not easy to determine, since sexual relations are by their nature private and intimate. Evidence of abuse or mistreatment is one thing. 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. Acknowledging sexual rights means giving patients the privacy to have sexual relationships. However, they can observe whether the resident is happy to see and be with the spouse, and whether she seems upset after visits. 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.