Sexual Education and Intellectual Disabilities

This article talks about the lack of access to sexual education for people with disabilities, especially intellectual disabilities. Of course, sexual education classes in the US are already generally abstinence only, not scientifically correct, and only talk about heterosexual penis and vagina sex, but even these subpar sexual education classes are often inaccessible for people with intellectual disabilities for a variety of reasons (their parents may opt them out or it might be taught as part of a gym class that they do not attend, for example). It is also often assumed that parents will take care of any sexual education, and many parents are afraid that they will do an inadequate job or are simply unwilling to see their children as sexual beings in the first place. This is of course exacerbated in the cases of parents who already infantilize their disabled children.

Another aspect of sexual education that the article highlights is a lack of discussion about sexuality. The article mentions the case of one woman who identifies as asexual and for a long time struggled to determine if her asexuality was caused by her autism or not (she eventually determined that it wasn’t). In this way, the assumption that all disabled people are asexual is harmful not only to those who are not asexual but also those who are, because asexual people with disabilities can be assumed by others to be misinformed or brainwashed about their own sexuality or feel shame for inadvertently validating the assumption that disabled people are not sexual. Needless to say, figuring out your sexuality is often a really difficult process, but it is much more difficult when you are not given access to sexual information. Not only is this dangerous for medical reasons, but it can also be emotionally harmful, especially if your sexuality is not normative. And, as in the case of the woman in the article, disability and non-normative sexuality can be thought of related or causal, especially when the person is also marginalized for other aspects of their identity.

I also read an old, fairly bad article that mostly focuses on parents of adults with developmental disabilities who receive sexual education. In this article, sexual education for people with intellectual and developmental disabilities is framed not as a logical process but instead as a necessary evil (“if you hide from this issue, it will come back to haunt you”). This attitude is patronizing and unfortunately it reflects the stigmatization of sexual education in general. Notably, our society thinks of sexual education as instructing people how to have sex (which is true, and which it definitely an important part) but this is not all sexual education can do. For example, in the Netherlands, where comprehensive sexual education starts when children are four years old, people learn not just about sex but also about love, body image, having healthy relationships, sexuality, and consent. Considering that people with disabilities are much more likely to be victims of abuse, such a comprehensive sex education would especially be of use to people with intellectual and developmental disabilities because it would better equip them to talk about their boundaries and advocate for themselves when they have been abused rather than being left to contemplate isolation and shame on their own. And, of course, it would help them have safer sexual freedom. Clearly, we need to change the way we think about, structure, and use sexual education in the United States.

Physician-Assisted Suicide Legislation

TW: suicide (physician-assisted), medical model, ableism, family coercion/abuse

A few weeks ago, Canada’s new Prime Minister Justin Trudeau proposed legislation for the legalization of physician-assisted death. According to this article, patients qualify for this treatment if they are “consenting adults” who have a “serious and incurable illness” which causes them psychological or physical suffering. Additionally, a doctor must declare that a natural death is “reasonably foreseeable,” though there is no required timeline for this foreseeable natural death and the patient’s condition is also not required to be terminal. A number of safeguards have been suggested to prevent the misuse of this system: the patient must sign a written request with two witnesses present, two different physicians must agree that the “treatment” is appropriate for that patient, and the patient is required to wait fifteen days before making the decision.

Interestingly, the article highlights that the many proponents of physician-assisted suicide are against the legislation because it is too restrictive and does not allow enough people, such as mature minors or people in early stages of rapidly progressing illnesses to get suicide assistance. However, the article makes little mention of opponents of Trudeau’s new legislation other than noting that a number of religious groups are critical of legalizing assisted death. In fact, none of the articles I found about the announcement of the new legislation discuss the possible dangers of implementing these laws, even though I easily found disability-focused articles about physician-assisted suicide in general. In any case, this legislation stood out to me for several reasons.

The first reason is that the language is incredibly open-ended. For example, a person’s eligibility for the death assistance is that natural death is expected in the “reasonably foreseeable future,” according to the doctor. Not only is this incredibly open to interpretation, and doctors frequently misjudge the length and “quality” of patients’ lives anyway. I was also intrigued by the fifteen-day waiting period. It is clearly designed to allow patients to reflect and not make quick decisions about the ends of their life, but I want to know: why fifteen days? If a person has just received a bleak diagnosis, for example, is fifteen days a reasonable amount of time to think through what the rest of their life might be like? According to a 2002 report on Oregon’s assisted-suicide law, the most common reasons people requested assistance in suicide were “fear of losing autonomy,” “fear of decreased ability to do enjoyable activities,” “fear of losing control of bodily function,” and “fear of being a burden.” Does fifteen days adequately allow a person to challenge internalized ableist assumptions that life is not worth living unless you are autonomous, independent, your body functions normally, and you have access to all of your favorite activities?

I also have other concerns. Would this legislation disproportionately appeal to those who lack familial or support? What if family members coerce a person into requesting this because they don’t want to help take care of them—would the laws sufficiently protect against such familial abuse? Or will patients, afraid of being a financial in additional to physical burden, turn to this practice as a more affordable alternative to medical costs? Finally, it is startling that this legislation is so overwhelmingly and uncritically supported (except to deem it not inclusive enough). I understand why such an option is so popular given the ableism and lack of structural support in our society, and I am not completely against the practice for some individuals, but it worries me that death is so readily offered as a championed, obvious alternative to a life with illness. I am worried that this legislation, and its enthusiastic support, perpetuates the ableist idea that a life with disability and suffering is not a life worth living.

Main article: http://www.nytimes.com/2016/04/15/world/americas/canadian-prime-minister-seeks-to-legalize-physician-assistedsuicide.html